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Please fill out the form below to register.

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Your Name:*

Email:*

Please select the location of the youth club your child attends:*

Name of Child:*

Child's Gender:*

Date of Birth:*

Address (including postcode):*

Name of Parent/Carer:*

Contact Address (If different from above):

Daytime Telephone:

Evening Telephone:

Mobile Telephone:

Emergency Contact Name:*

Relationship to the child:*

Emergency Contact Telephone Number:*

Emergency Contact Address (including postcode):*

Name of GP:*

GP's Telephone Number:*

GP's Address:*

Date of Last Anti Tetanus Injection:*

Does Your Child Have Any Illness/Disability:*

Details of Any Illness/Disability:

Will Your Child Be On Any Medications At The Time Of Camp:*

Details of any medication required during the camp (all medication must be labelled correctly and clearly with name and dose needed each day):

Does Your Child Have Any Allergies (for example, to Face Paints):*

Details of any allergies:

Does Your Child Have Any Special Dietary Requirements:

Details of any special dietary requirements:

Travel arrangements

As an alternative this year we are inviting parents/carers to drop their children off at Camp. This would give you an opportunity to see the St Madoc Centre, the woods and the beach. You'll also meet the staff and sample some Camp food!

You can still book a place on the coach by selecting the option below, if you'd prefer.

Please Note: All children will be brought home by coach.

Would you like to book a seat on the coach to Camp?*

Consent regarding Camp activities:

Listed below are activities undertaken at Camp that require consent.

Please read the details below, and those listed below the form, and then choose "I Consent" to give your consent.

Any exclusions can be listed in the space below, however, please note that should you list activities here your child will be unable to join in that activity for the duration of the week.

Health Care:

In an emergency and/or if I am not contactable, I am willing to permit Doctor / hospital or dental treatment including an anaesthetic. I am also willing to permit any First Aid treatment as may be deemed necessary by a qualified First Aider.

Outings:

During Camp, visits may be made to local beaches, dunes and woodland areas and other places of interest.

Swimming:

This may include some swimming in in the sea from the local beaches. Swimming will only take place on beaches recommended by the St Madoc Centre and careful note of conditions prevailing will always be taken.

In the sea, Camp Leaders will keep a watchful eye on all children and monitor the depth of the water that is being used. This will be effected by always having two leaders in the sea at the furthest limit children are allowed to proceed to.

Please note on the registration form if your child is unable to swim or needs careful monitoring.

Details of any regular medication, medical problem (e.g. asthma, epilepsy, diabetes, allergies, dietary needs, etc.) or disability which may affect the swimming activity need to be completed in the health section of the registration form (above).

Swimming:*

Swimming comments (if required):

During a typical week of camp your child may be involved in any of the following:

Sea activities (which may include games on the water margin),
Dodge ball,
General activities,
Transport (such as outings and swimming),
Photographs/Videos taken for use during Camp and afterwards in Camp promotion.

This list is representative of the types of activities campers engage in but is not exhaustive. Your child may be involved in other activities of a similar nature to those outlined on this list.

I confirm that my child is in good health and I consider him/her fit to participate in the activities above and consent to him/her doing so. I give consent for the child named on this form to receive health care and first aid as outlined on this form.

Consent:*

Any Exceptions:

By submitting this form I confirm that I have read and understood the content above and below, and that, to the best of my knowledge, the details I have provided are both correct and accurate.*

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