Camp Step 1 of 6 16% What would you like to do?*Register to attend a camp Child's Name*Parent's Name*Mobile Number*Email* CAMPER'S DETAILSFull Name*School*Year LevelDate of Birth* MobileAddress*Suburb*Postcode*VegetarianYesNoDietary Requirements (All food is Kosher) PARENT'S DETAILSMum's NameMobile*EmailDad's NameEmailI am happy for my child's name and phone number to appear on a camp contact listYesNo MEDICAL INFORMATIONCamper's NameName of Family DoctorDoctor's Phone*Medicare Number*Private Health Fund*Membership NumberAllergiesYesNoPlease describe the allergyDate of last tetanus injection AsthmaticYesNoPlease describe asthma management planAnaphylaticYesNoPlease describe anaphylaxis management planPlease outline anything that may affect your child's participation or enjoyment of the campPlease list all medication that will be brought to camp Terms and Conditions I, the undersigned parent/guardian of the applicant named above, HEREBY PERMIT him/her to participate in the UJEB Camp and associated activities commencing on Thursday 12th to Sunday 15th of April AND IN CONSIDERATION of the application being accepted for such a camp at my request HEREBY INDEMNIFY and hold indemnified the United Jewish Education Board and each and every one of its members, servants or agents against all action, claims, demands, losses, damages, costs and expenses for which they may become liable as a result of the applicant sustaining any injury, illness, loss or damage while participating in the said camp (including traveling to and from the camp and associated activities including excursions). This indemnity shall be limited to the extent that the UJEB, its members, servants or agents are not indemnified by the monies recovered from insurances effected by or on behalf of the UJEB. I warrant the particulars of the applicant’s health and medical history contained in this application are true and complete. I hereby authorise and appoint the head of camp or anyone duly appointed by him/her to authorise and arrange any necessary medical or hospital treatment which the applicant my require. UJEB promotes Child Protection and has a strict code of conduct for all camps. I, the parent/guardian of the named applicant hereby give permission for him/her to participate in the UJEB camp from Thursday 12th to Sunday 15th of April 2018. I give permission for photographs to be taken of my child which may be used for camp/UJEB publicity purposes. I also authorise medical attention to be administered to him her should it be deemed necessary by the camp administrators.I accept the terms and conditions* Tick to accept This iframe contains the logic required to handle Ajax powered Gravity Forms.