Event Registration - Latimer Church

Event*

Name*

First Last

Spouse:

First Last

Child's name*

First Last

Please fill in a separate form for each child attending Youth Group Camp

Number of children*

Child 1 (Name and Age)*

Child 2 (Name and Age)*

Child 3 (Name and Age)*

Child 4 (Name and Age)*

Child 5 (Name and Age)*

Gender*

Male
Female

Age*

Date of birth

School currently attending*

School Year*

Friends also attending Holiday Club

Day's attending*

Monday
Tuesday
Wednesday
Thursday
Friday

Address*

Street Address Address Line 2 City ZIP / Postal Code

Parent/Caregiver's Name*

First Last

Home Phone

Phone*

Email*

Emergency contact phone*

Name of second emergency contact if primary caregiver can't be reached*

First Last

Phone number for emergency contact*

Allergies, special needs or things we need to know about

Suburb / Area

Can you provide a tent?

Yes
No

If yes, how many can people can your tent sleep?

Registration*

Full weekend ($140)
Saturday ($20 - dinner included)
Sunday ($20 - dinner included)

Dietary Requirements / Allergies etc

Preferred Time of Group:*

Tuesday evening
Wednesday evening
Thursday evening
Other (please comment below)

Which service do you attend at St John's?*

8:30am
10am
4:15pm
7pm

Mobile

Team Members

Optional - you can register a whole team (6 people), or just yourself / part of a team and we will assign you a team.

Name

Camp package*

Family - Accommodation ($300) - FULL
Individual adult - Accommodation ($100) - FULL
Child aged 2-17 - Accommodation ($50) - FULL
Family - TENTING ($200)
Adult - TENTING ($75)
Child - TENTING ($30)
Saturday only ($25 adult / $15 child)

Number of guests

Comments/Other information: