Camp registration details:
This form must be completed by a parent/guardian/carer
that has lawful authority in relation to the child. Please notify St Mary’s Sporting Club of any change of address, phone number or medical information. We aim to provide your child with care of the highest standard within a safe, secure and stimulating environment. St Mary’s Sporting Club representatives and parents assisting at the camp will be required to have a Working with Children Check and a First Aid qualified representative will be on hand at all times throughout the camp.
Member/Player Name: *
Usually called (Nickname): DOB: *
Age: * Year Level/Grade: * Gender: * Parent/Guardian details: Parent/Guardian 1 - Full Name *
* Mobile number: * Email *
Parent/Guardian 2 - Full Name *
Parent/Guardian 2 mobile number: * Medical and health information: Medicare No: *
Medicare number including final digit card number.
Medicare Card exp date: (mm/yy) * Medicare Card Ref No * Ambulance cover: * Permission to call an ambulance: * Private Health Cover: * Dietary requirements: *
If your child has a dietary requirement please include below. If this requirement is due to an allergy please complete the dietary requirement section and the allergy section.
Other dietary requirement: Medical conditions: * Other medical conditions:
Provide full details
Does your child take any prescription medications? *
If YES – a Webster pack containing the prescribed tablets from your chemist MUST be provided when your child is dropped off. If a Webster pack is not provided the child will not be able to attend camp. All medications (prescription or over the counter) must be in the original packaging.
If your child is on any other prescription medication (such as syrup, ointment, Ventolin/Asthma puffer, spray or cream) a letter must be supplied by the parent/guardian giving permission for St Mary’s representatives to give your child their medication, plus dosage and times.
Approval for Prescription medication to be given? * Approval for Panadol to be given if necessary? * Allergies: *
If your child is allergic to any medication, food or something else, please describe your child’s condition, any signs and symptoms of the allergy or sensitivity and how you would prefer our representatives to respond.
Please provide full details of the allergy including Type, Signs, Symptoms and preferred treatment. If the allergy is severe you must upload an Alergy Action Plan.
File Max. file size: 24 MB. File Max. file size: 24 MB. Has your child had any serious illness, accident or operations recently? *
If yes please provide details
Details: COVID declaration: *
I declare that I/my child is not experiencing any COVID-19 symptoms and I have not been a close contact.
If I experience any symptoms, or a household contact has symptoms, I will not attend the camp, unless I have a negative Rapid Antigen Test.
Medical and treatment declaration: *
We may need to use a wide variety of sunscreens and insect repellents. If your child requires a specific brand please provide this in a clearly named and labelled container. These should be given to a St Mary's representative at the start of the camp. If my child has lice/nits, I agree to collect from camp immediately.
Please nominate someone at a different address to where your child lives to collect your child in case of an emergency or inappropriate behaviour. Identification must be produced on request to a St Mary's representative.
Emergency mobile number: * Relationship to child * Declaration: Photographic Consent: *
Your child may be photographed or videoed whilst at the Camp and these photos may be included in a camp DVD. A selection of these photos/videos may be used for historical or promotional materials or included on the St Marys Sporting Club website. No identifying personal information will be released.
I DECLARE that the above particulars are, to the best of my knowledge, and belief, true and correct.
AUTHORITY of the child referred to in this enrolment form, declare that the information provided for the purpose of this enrolment is true and correct and that I undertake to immediately inform the ST MARYS SPORTING CLUB in the event of any change to this information I agree to collect or make arrangements for the collection of the child referred to in this enrolment form if she/he becomes unwell or for inappropriate behaviour.
In the event of my child contracting an illness or requiring medical attention, I authorise the person in charge to act as considered necessary in the interests of my child. I will reimburse any necessary expenses incurred by the St Marys Sporting Club.
Privacy Declaration: *
ST MARYS SPORTING CLUB acknowledges and respects privacy of individuals. The information that is being collected on this document is for the purposes of processing your enrolment in a ST MARYS SPORTING CLUB external activity. The personal information collected is of the
parents/guardians/carers and the child attending the camp. By completing this form, ST MARYS SPORTING CLUB accepts that the parents/guardians/carers of the child have consented for this information to be collected. The intended recipients of this information are ST MARYS SPORTING CLUB and its authorised representatives. You have the right to access and alter personal information concerning yourself and/or your child in accordance with the Commonwealth Privacy Act (Amended 2001).
NOTE: If you choose not to have your personal information transferred to medical professionals, your child's first aid treatment may be restricted.