Hub Club KAOS - Camp Kedron 2025 • Christ Church

Child Ticket 0

Child's Information

First Name *

Last Name *

Gender *

Date of Birth *

School Grade *

School Name *

Home Address *

Home City *

Home State *

Home Postcode *

Child's Health & Medical Information

Medicare number *

Medicare reference number *

Medicare Expiry *

Health Fund Name

Health Fund Membership Number

Do you have Ambulance Cover?

Yes

Date of Last Tetanus Booster

Please detail any allergies (food, drug, environmental) and any medication taken.

Please detail any special dietary requirements needed.

Please detail if your child is restricted from any activity, has a disability (physical, mental, learning, emotional) or any other relevant medical concerns

To prevent possible embarrassment, does your child:

Wet the bed?

Sleep walk?

Parent/Guardian & Emergency Contact Information

Parent/Guardian Information

Parent/Guardian 1: Full Name *

Parent/Guardian 1: Phone number *

Email Address *

Emergency Contact Information

Alternate Emergency Contact: Full Name *

Alternate Emergency Contact: Phone Number *

Relationship to child *

Permissions, Payment & Indemnity

Permissions

Is anyone legally restricted from seeing this child? If yes, please provide details.

I give permission for my child to have administered by first aid qualified leaders if necessary:

Basic first aid

Anti-histamine for allergies

Pain medicine (eg panadol)

I give permission for my child to have their photos and/or videos taken while on camp for: *

In church services and children's programs

On church website, printed material and for training others

Indemnity

Please read and sign below:

My signature below indicates my willingness to permit my child to participate fully in all activities associated with the camp on 1st August - 3rd August 2025, including (but not limited to) those listed above, bush walking and regular games. In the case of a medical emergency, I hereby give permission to the Doctor chosen by the camp director to secure proper treatment for and/or hospitalisation, injection, anaesthetic, or surgery for my child as named. I understand that every effort will be made to contact me prior to instituting such procedures.

Parent or guardian's signature certifying acceptance of all conditions thereon:

Parent/Guardians Signature (initials) *

Date Signed *

Sibling Ticket (2nd or 3rd child in the family) 0

Child's Information

First Name *

Last Name *

Gender *

Date of Birth *

School Grade *

School Name *

Home Address *

Home City *

Home State *

Home Postcode *

Child's Health & Medical Information

Medicare number *

Medicare reference number *

Medicare Expiry *

Health Fund Name

Health Fund Membership Number

Do you have Ambulance Cover?

Yes

Date of Last Tetanus Booster

Please detail any allergies (food, drug, environmental) and any medication taken.

Please detail any special dietary requirements needed.

Please detail if your child is restricted from any activity, has a disability (physical, mental, learning, emotional) or any other relevant medical concerns

To prevent possible embarrassment, does your child:

Wet the bed?

Sleep walk?

Parent/Guardian & Emergency Contact Information

Parent/Guardian Information

Parent/Guardian 1: Full Name *

Parent/Guardian 1: Phone number *

Email Address *

Emergency Contact Information

Alternate Emergency Contact: Full Name *

Alternate Emergency Contact: Phone Number *

Relationship to child *

Permissions, Payment & Indemnity

Permissions

Is anyone legally restricted from seeing this child? If yes, please provide details.

I give permission for my child to have administered by first aid qualified leaders if necessary:

Basic first aid

Anti-histamine for allergies

Pain medicine (eg panadol)

I give permission for my child to have their photos and/or videos taken while on camp for: *

In church services and children's programs

On church website, printed material and for training others

Indemnity

Please read and sign below:

Parent or guardian's signature certifying acceptance of all conditions thereon:

Parent/Guardians Signature (initials) *

Date Signed *

Hub Club KAOS - Camp Kedron 2025

Camp Kedron 2025 - Weekend Away for Year 3-6

Date & Time

Child Ticket 0

Child's Information

Child's Health & Medical Information

Parent/Guardian & Emergency Contact Information

Parent/Guardian Information

Emergency Contact Information

Permissions, Payment & Indemnity

Permissions

Indemnity

Sibling Ticket (2nd or 3rd child in the family) 0

Child's Information

Child's Health & Medical Information

Parent/Guardian & Emergency Contact Information

Parent/Guardian Information

Emergency Contact Information

Permissions, Payment & Indemnity

Permissions

Indemnity