KYCK 2022 • St Philips Eastwood Anglican

KYCK Ticket 0

KYCK 2022 Registration Form

Family Details

Parent 1 Name *

Parent 2 Name

Emergency Contact Name *

Address *

Post Code *

Parent 1 Phone *

Parent 2 Phone

Emergency Contact Number *

Suburb *

Parents Email Address *

How would you like us to communicate KYCK updates with you and your child? *

Family Health Information

Doctor Name

Medicare Number *

Doctor Contact

Private Health Insurer

Private Health Membership Number

Camper 1 Details

Camper 1 Name *

Camper 1's Email (optional)

Camper 1 Date of Birth *

Camper 1 Medicare Card Reference Number *

Any Allergies?

Any Dietary Requirements?

Any Activity Restrictions?

Camper 1 Gender *

Camper 1's Phone Number (optional)

Camper 1 School Year in 2022 *

Camper 1 Date of Last Tetanus *

Any other health information we should know?

Tip: Respiratory, muscular, epilepsy, etc.

If you are only registering one child for camp, please scroll down to finalise your registration. If you are registering 2 or 3 children for camp, please fill in the extra camper details below before finalising your registration.

Camper 2 Details

Camper 2 Name

Camper 2's Email Address (optional)

Camper 2 Date of Birth

Camper 2 Medicare Reference Number

Any Allergies?

Any Dietary Requirements?

Any Activity Restrictions?

Camper 2 Gender

Camper 2's Phone Number (Optional)

Camper 2 School Year in 2022

Camper 2 Date of Last Tetanus

Any other health information we should know?

Camper 3 Details

Camper 3 Name

Camper 3's Email Address (Optional)

Camper 3 Date of Birth

Camper 3 Medicare Reference Number

Any Allergies?

Any Dietary Requirements?

Any Activity Restrictions?

Camper 3 Gender

Camper 3's Phone Number (Optional)

Camper 3 School Year in 2022

Camper 3 Date of Last Tetanus

Any other health information we should know?

Permission

Photos/videos of my child/children may be displayed and used to promote the group *

Additional Notes

Tip: Anything else the Full On team should know?

Checking the box below indicates:

My willingness to permit my child to participate fully in the KYCK at Katoomba Christian Convention trip organised by Eastwood Anglican Church
That I give my permission, in the case of a medical emergency, to the doctor chosen (either by the church authorities or other persons supervising or administering the activities), to secure proper treatment for and/or order hospitalisation, injection, anaesthetic or surgery for my child as named. I understand every effort will be made to contact me prior to instituting such procedures.

I consent to the above. *

The leadership team of the aforementioned group will treat the information contained confidentially. This information may be shared with a third party when it concerns medical health or care of the individuals listed. If you wish to access this information or have any queries in relation to the manner in which we handle your personal information, please do not hesitate to contact Jason - jason@stphils.org.au

Subsidies and financial assistance are available to those who are unable to meet the full cost of KYCK. If this is you send an email to Jason - jason@stphils.org.au which indicates the amount you are able to pay, and subsidies will be organised.

KYCK Ticket for 2 0

KYCK 2022 Registration Form

Family Details

Parent 1 Name *

Parent 2 Name

Emergency Contact Name *

Address *

Post Code *

Parent 1 Phone *

Parent 2 Phone

Emergency Contact Number *

Suburb *

Parents Email Address *

How would you like us to communicate KYCK updates with you and your child? *

Family Health Information

Doctor Name

Medicare Number *

Doctor Contact

Private Health Insurer

Private Health Membership Number

Camper 1 Details

Camper 1 Name *

Camper 1's Email (optional)

Camper 1 Date of Birth *

Camper 1 Medicare Card Reference Number *

Any Allergies?

Any Dietary Requirements?

Any Activity Restrictions?

Camper 1 Gender *

Camper 1's Phone Number (optional)

Camper 1 School Year in 2022 *

Camper 1 Date of Last Tetanus *

Any other health information we should know?

Tip: Respiratory, muscular, epilepsy, etc.

If you are only registering one child for camp, please scroll down to finalise your registration. If you are registering 2 or 3 children for camp, please fill in the extra camper details below before finalising your registration.

Camper 2 Details

Camper 2 Name

Camper 2's Email Address (optional)

Camper 2 Date of Birth

Camper 2 Medicare Reference Number

Any Allergies?

Any Dietary Requirements?

Any Activity Restrictions?

Camper 2 Gender

Camper 2's Phone Number (Optional)

Camper 2 School Year in 2022

Camper 2 Date of Last Tetanus

Any other health information we should know?

Camper 3 Details

Camper 3 Name

Camper 3's Email Address (Optional)

Camper 3 Date of Birth

Camper 3 Medicare Reference Number

Any Allergies?

Any Dietary Requirements?

Any Activity Restrictions?

Camper 3 Gender

Camper 3's Phone Number (Optional)

Camper 3 School Year in 2022

Camper 3 Date of Last Tetanus

Any other health information we should know?

Permission

Photos/videos of my child/children may be displayed and used to promote the group *

Additional Notes

Tip: Anything else the Full On team should know?

Checking the box below indicates:

My willingness to permit my child to participate fully in the KYCK at Katoomba Christian Convention trip organised by Eastwood Anglican Church
That I give my permission, in the case of a medical emergency, to the doctor chosen (either by the church authorities or other persons supervising or administering the activities), to secure proper treatment for and/or order hospitalisation, injection, anaesthetic or surgery for my child as named. I understand every effort will be made to contact me prior to instituting such procedures.

I consent to the above. *

The leadership team of the aforementioned group will treat the information contained confidentially. This information may be shared with a third party when it concerns medical health or care of the individuals listed. If you wish to access this information or have any queries in relation to the manner in which we handle your personal information, please do not hesitate to contact Jason - jason@stphils.org.au

Subsidies and financial assistance are available to those who are unable to meet the full cost of KYCK. If this is you send an email to Jason - jason@stphils.org.au which indicates the amount you are able to pay, and subsidies will be organised.

KYCK Ticket for 3 0

KYCK 2022 Registration Form

Family Details

Parent 1 Name *

Parent 2 Name

Emergency Contact Name *

Address *

Post Code *

Parent 1 Phone *

Parent 2 Phone

Emergency Contact Number *

Suburb *

Parents Email Address *

How would you like us to communicate KYCK updates with you and your child? *

Family Health Information

Doctor Name

Medicare Number *

Doctor Contact

Private Health Insurer

Private Health Membership Number

Camper 1 Details

Camper 1 Name *

Camper 1's Email (optional)

Camper 1 Date of Birth *

Camper 1 Medicare Card Reference Number *

Any Allergies?

Any Dietary Requirements?

Any Activity Restrictions?

Camper 1 Gender *

Camper 1's Phone Number (optional)

Camper 1 School Year in 2022 *

Camper 1 Date of Last Tetanus *

Any other health information we should know?

Tip: Respiratory, muscular, epilepsy, etc.

If you are only registering one child for camp, please scroll down to finalise your registration. If you are registering 2 or 3 children for camp, please fill in the extra camper details below before finalising your registration.

Camper 2 Details

Camper 2 Name

Camper 2's Email Address (optional)

Camper 2 Date of Birth

Camper 2 Medicare Reference Number

Any Allergies?

Any Dietary Requirements?

Any Activity Restrictions?

Camper 2 Gender

Camper 2's Phone Number (Optional)

Camper 2 School Year in 2022

Camper 2 Date of Last Tetanus

Any other health information we should know?

Camper 3 Details

Camper 3 Name

Camper 3's Email Address (Optional)

Camper 3 Date of Birth

Camper 3 Medicare Reference Number

Any Allergies?

Any Dietary Requirements?

Any Activity Restrictions?

Camper 3 Gender

Camper 3's Phone Number (Optional)

Camper 3 School Year in 2022

Camper 3 Date of Last Tetanus

Any other health information we should know?

Permission

Photos/videos of my child/children may be displayed and used to promote the group *

Additional Notes

Tip: Anything else the Full On team should know?

Checking the box below indicates:

My willingness to permit my child to participate fully in the KYCK at Katoomba Christian Convention trip organised by Eastwood Anglican Church
That I give my permission, in the case of a medical emergency, to the doctor chosen (either by the church authorities or other persons supervising or administering the activities), to secure proper treatment for and/or order hospitalisation, injection, anaesthetic or surgery for my child as named. I understand every effort will be made to contact me prior to instituting such procedures.

I consent to the above. *

The leadership team of the aforementioned group will treat the information contained confidentially. This information may be shared with a third party when it concerns medical health or care of the individuals listed. If you wish to access this information or have any queries in relation to the manner in which we handle your personal information, please do not hesitate to contact Jason - jason@stphils.org.au

Subsidies and financial assistance are available to those who are unable to meet the full cost of KYCK. If this is you send an email to Jason - jason@stphils.org.au which indicates the amount you are able to pay, and subsidies will be organised.

Leaders Ticket 0

KYCK 2022 Registration Form

Family Details

Parent 1 Name *

Parent 2 Name

Emergency Contact Name *

Address *

Post Code *

Parent 1 Phone *

Parent 2 Phone

Emergency Contact Number *

Suburb *

Parents Email Address *

How would you like us to communicate KYCK updates with you and your child? *

Family Health Information

Doctor Name

Medicare Number *

Doctor Contact

Private Health Insurer

Private Health Membership Number

Camper 1 Details

Camper 1 Name *

Camper 1's Email (optional)

Camper 1 Date of Birth *

Camper 1 Medicare Card Reference Number *

Any Allergies?

Any Dietary Requirements?

Any Activity Restrictions?

Camper 1 Gender *

Camper 1's Phone Number (optional)

Camper 1 School Year in 2022 *

Camper 1 Date of Last Tetanus *

Any other health information we should know?

Tip: Respiratory, muscular, epilepsy, etc.

If you are only registering one child for camp, please scroll down to finalise your registration. If you are registering 2 or 3 children for camp, please fill in the extra camper details below before finalising your registration.

Camper 2 Details

Camper 2 Name

Camper 2's Email Address (optional)

Camper 2 Date of Birth

Camper 2 Medicare Reference Number

Any Allergies?

Any Dietary Requirements?

Any Activity Restrictions?

Camper 2 Gender

Camper 2's Phone Number (Optional)

Camper 2 School Year in 2022

Camper 2 Date of Last Tetanus

Any other health information we should know?

Camper 3 Details

Camper 3 Name

Camper 3's Email Address (Optional)

Camper 3 Date of Birth

Camper 3 Medicare Reference Number

Any Allergies?

Any Dietary Requirements?

Any Activity Restrictions?

Camper 3 Gender

Camper 3's Phone Number (Optional)

Camper 3 School Year in 2022

Camper 3 Date of Last Tetanus

Any other health information we should know?

Permission

Photos/videos of my child/children may be displayed and used to promote the group *

Additional Notes

Tip: Anything else the Full On team should know?

Checking the box below indicates:

My willingness to permit my child to participate fully in the KYCK at Katoomba Christian Convention trip organised by Eastwood Anglican Church
That I give my permission, in the case of a medical emergency, to the doctor chosen (either by the church authorities or other persons supervising or administering the activities), to secure proper treatment for and/or order hospitalisation, injection, anaesthetic or surgery for my child as named. I understand every effort will be made to contact me prior to instituting such procedures.

I consent to the above. *

The leadership team of the aforementioned group will treat the information contained confidentially. This information may be shared with a third party when it concerns medical health or care of the individuals listed. If you wish to access this information or have any queries in relation to the manner in which we handle your personal information, please do not hesitate to contact Jason - jason@stphils.org.au

Subsidies and financial assistance are available to those who are unable to meet the full cost of KYCK. If this is you send an email to Jason - jason@stphils.org.au which indicates the amount you are able to pay, and subsidies will be organised.