Church Camp 2026 • Emmanuel Uniting Church

Adult Day visitor 0

Personal Information

Please complete fields as appropriate for all adults and children who will be attending Church Camp 2026

First Name *

Last Name *

Preferred Name (for name tag) *

Gender *

Date of Birth *

Home Phone Number

Mobile Number

Email Address

Tip: of person who will manage registration and need to receive information about Holiday Club

Home Address

Home Address Line 2

Home Suburb

Home State

Home Postcode

Medical information

Please complete all fields as appropriate so that we can best care for you/your child/ren while in our care.

Do you have any Dietary Requirements, food or other Allergies? *

Details of Dietary Requirements & Allergies.

Tip: Please give as much detail as possible to allow caterers to provide for your needs

I will be at Church Camp...

Tip: Please provide as much detail about the times you will arrive and depart camp. i.e. arriving early Thursday, or only visiting for Saturday.

Do you have Anaphylaxis? *

Yes

No

Do you have Asthma? *

Yes

No

Details of Anaphylaxis, Asthma, Medical Conditions and other Care Needs (including custody arrangements if applicable)

Action Plan for Medical, Behavioral and Other Care Needs

Tip: Please forward documentation as required

Private Health Insurance

Private Health Insurance Provider

Private Health Insurance Member number

Medicare Number & Reference

Next of Kin & Emergency Contacts

Please list Next of Kin and at least one other person that we can contact should something happen to you while at Church Camp.

Next of Kin First Name

Next of Kin Last Name

Next of Kin Relationship

Next of Kin Phone Number

Emergency Contact 1 Name

Emergency Contact 1 Relationship

Emergency Contact 1 Phone Number

Emergency Contact 2 Name

Emergency Contact 2 Relationship

Emergency Contact 2 Phone Number

Privacy Statement, Consent, Indemnity, Photography and Media Release

Protecting your privacy is import to us. The information we seek allows us to manage risk, provide reasonable care and allow for your involvement in our program. We only ask for information that is necessary for managing the programs that you/ your child/ren are participating in and are careful to keep your information confidential and provide it only to those who require access to it for your care. If you have any questions about your information or how it is stored please contact the church office.

Release Statement *

At times the activities of Church Camp will be photographed, audio and or visually recorded. Do you give permission for Emmanuel Uniting Church to use photos or digital media taken by us which may identify yourself/ your child/ren? Note: Names identifying children will never be posted with images. Please read all 5 options here and tick those that you agree to. I consent to myself/my child/ren becoming a member of and taking part in the overall activities of Emmanuel Uniting Church. I confirm that I have provided details of any physical, mental or health conditions of myself/my child/ren which may impact upon their participation, or which has the potential to put them or any other person at risk. I confirm that I will advise the program coordinator and activity leader of any change of circumstances that would affect the care of myself/ my child/ren, their participation in the activity, or changes to the details of this form. I understand that if urgent medical attention is needed, every effort will be made to contact the persons listed on this form. In the event that they cannot be contacted in an emergency, I give my permission for myself/ my child/ren to receive medical treatment as deemed necessary by the leaders of the program/activity (including transport via Ambulance). Should this be necessary, I understand that I will be notified as soon as possible. I consent to information about myself/ my child/ren being collected and used for the running of activities and reporting of incidents and accidents.

At times the activities of Church Camp will be photographed, audio and or visually recorded. Do you give permission for Emmanuel Uniting Church to use photos or digital media taken by us which may identify yourself/ your child/ren?

Note: Names identifying children will never be posted with images.

Please read all 5 options here and tick those that you agree to.

Photography and Media Release *

Yes, Images and media may be used in print for Church use (i.e. on physical notice boards and in-house presentations)

Yes, Images and media may be used in print for any public media (including but not limited to physical notice boards, Promotional material and newspapers)

Yes, Images and media may be used online in any public social media pages or websites (including but not limited to Emmanuel Uniting Church Social Media pages and websites)

No, Images and media may NOT be used in any circumstance

Date *

Signed (Name) *

Tip: Please type your name here in acknowledgment of form completion

Child Day visitor 0

Personal Information

Please complete fields as appropriate for all adults and children who will be attending Church Camp 2026

First Name *

Last Name *

Preferred Name (for name tag) *

Gender *

Date of Birth *

Home Phone Number

Mobile Number

Email Address

Tip: of person who will manage registration and need to receive information about Holiday Club

Home Address

Home Address Line 2

Home Suburb

Home State

Home Postcode

Medical information

Please complete all fields as appropriate so that we can best care for you/your child/ren while in our care.

Do you have any Dietary Requirements, food or other Allergies? *

Details of Dietary Requirements & Allergies.

Tip: Please give as much detail as possible to allow caterers to provide for your needs

I will be at Church Camp...

Tip: Please provide as much detail about the times you will arrive and depart camp. i.e. arriving early Thursday, or only visiting for Saturday.

Do you have Anaphylaxis? *

Yes

No

Do you have Asthma? *

Yes

No

Details of Anaphylaxis, Asthma, Medical Conditions and other Care Needs (including custody arrangements if applicable)

Action Plan for Medical, Behavioral and Other Care Needs

Tip: Please forward documentation as required

Private Health Insurance

Private Health Insurance Provider

Private Health Insurance Member number

Medicare Number & Reference

Next of Kin & Emergency Contacts

Please list Next of Kin and at least one other person that we can contact should something happen to you while at Church Camp.

Next of Kin First Name

Next of Kin Last Name

Next of Kin Relationship

Next of Kin Phone Number

Emergency Contact 1 Name

Emergency Contact 1 Relationship

Emergency Contact 1 Phone Number

Emergency Contact 2 Name

Emergency Contact 2 Relationship

Emergency Contact 2 Phone Number

Privacy Statement, Consent, Indemnity, Photography and Media Release

Protecting your privacy is import to us. The information we seek allows us to manage risk, provide reasonable care and allow for your involvement in our program. We only ask for information that is necessary for managing the programs that you/ your child/ren are participating in and are careful to keep your information confidential and provide it only to those who require access to it for your care. If you have any questions about your information or how it is stored please contact the church office.

Release Statement *

At times the activities of Church Camp will be photographed, audio and or visually recorded. Do you give permission for Emmanuel Uniting Church to use photos or digital media taken by us which may identify yourself/ your child/ren? Note: Names identifying children will never be posted with images. Please read all 5 options here and tick those that you agree to. I consent to myself/my child/ren becoming a member of and taking part in the overall activities of Emmanuel Uniting Church. I confirm that I have provided details of any physical, mental or health conditions of myself/my child/ren which may impact upon their participation, or which has the potential to put them or any other person at risk. I confirm that I will advise the program coordinator and activity leader of any change of circumstances that would affect the care of myself/ my child/ren, their participation in the activity, or changes to the details of this form. I understand that if urgent medical attention is needed, every effort will be made to contact the persons listed on this form. In the event that they cannot be contacted in an emergency, I give my permission for myself/ my child/ren to receive medical treatment as deemed necessary by the leaders of the program/activity (including transport via Ambulance). Should this be necessary, I understand that I will be notified as soon as possible. I consent to information about myself/ my child/ren being collected and used for the running of activities and reporting of incidents and accidents.

At times the activities of Church Camp will be photographed, audio and or visually recorded. Do you give permission for Emmanuel Uniting Church to use photos or digital media taken by us which may identify yourself/ your child/ren?

Note: Names identifying children will never be posted with images.

Please read all 5 options here and tick those that you agree to.

Photography and Media Release *

Yes, Images and media may be used in print for Church use (i.e. on physical notice boards and in-house presentations)

Yes, Images and media may be used in print for any public media (including but not limited to physical notice boards, Promotional material and newspapers)

Yes, Images and media may be used online in any public social media pages or websites (including but not limited to Emmanuel Uniting Church Social Media pages and websites)

No, Images and media may NOT be used in any circumstance

Date *

Signed (Name) *

Tip: Please type your name here in acknowledgment of form completion

Adult tent/caravan 1 night 0

Personal Information

Please complete fields as appropriate for all adults and children who will be attending Church Camp 2026

First Name *

Last Name *

Preferred Name (for name tag) *

Gender *

Date of Birth *

Home Phone Number

Mobile Number

Email Address

Tip: of person who will manage registration and need to receive information about Holiday Club

Home Address

Home Address Line 2

Home Suburb

Home State

Home Postcode

Medical information

Please complete all fields as appropriate so that we can best care for you/your child/ren while in our care.

Do you have any Dietary Requirements, food or other Allergies? *

Details of Dietary Requirements & Allergies.

Tip: Please give as much detail as possible to allow caterers to provide for your needs

I will be at Church Camp...

Tip: Please provide as much detail about the times you will arrive and depart camp. i.e. arriving early Thursday, or only visiting for Saturday.

Do you have Anaphylaxis? *

Yes

No

Do you have Asthma? *

Yes

No

Details of Anaphylaxis, Asthma, Medical Conditions and other Care Needs (including custody arrangements if applicable)

Action Plan for Medical, Behavioral and Other Care Needs

Tip: Please forward documentation as required

Private Health Insurance

Private Health Insurance Provider

Private Health Insurance Member number

Medicare Number & Reference

Next of Kin & Emergency Contacts

Please list Next of Kin and at least one other person that we can contact should something happen to you while at Church Camp.

Next of Kin First Name

Next of Kin Last Name

Next of Kin Relationship

Next of Kin Phone Number

Emergency Contact 1 Name

Emergency Contact 1 Relationship

Emergency Contact 1 Phone Number

Emergency Contact 2 Name

Emergency Contact 2 Relationship

Emergency Contact 2 Phone Number

Privacy Statement, Consent, Indemnity, Photography and Media Release

Protecting your privacy is import to us. The information we seek allows us to manage risk, provide reasonable care and allow for your involvement in our program. We only ask for information that is necessary for managing the programs that you/ your child/ren are participating in and are careful to keep your information confidential and provide it only to those who require access to it for your care. If you have any questions about your information or how it is stored please contact the church office.

Release Statement *

At times the activities of Church Camp will be photographed, audio and or visually recorded. Do you give permission for Emmanuel Uniting Church to use photos or digital media taken by us which may identify yourself/ your child/ren? Note: Names identifying children will never be posted with images. Please read all 5 options here and tick those that you agree to. I consent to myself/my child/ren becoming a member of and taking part in the overall activities of Emmanuel Uniting Church. I confirm that I have provided details of any physical, mental or health conditions of myself/my child/ren which may impact upon their participation, or which has the potential to put them or any other person at risk. I confirm that I will advise the program coordinator and activity leader of any change of circumstances that would affect the care of myself/ my child/ren, their participation in the activity, or changes to the details of this form. I understand that if urgent medical attention is needed, every effort will be made to contact the persons listed on this form. In the event that they cannot be contacted in an emergency, I give my permission for myself/ my child/ren to receive medical treatment as deemed necessary by the leaders of the program/activity (including transport via Ambulance). Should this be necessary, I understand that I will be notified as soon as possible. I consent to information about myself/ my child/ren being collected and used for the running of activities and reporting of incidents and accidents.

At times the activities of Church Camp will be photographed, audio and or visually recorded. Do you give permission for Emmanuel Uniting Church to use photos or digital media taken by us which may identify yourself/ your child/ren?

Note: Names identifying children will never be posted with images.

Please read all 5 options here and tick those that you agree to.

Photography and Media Release *

Yes, Images and media may be used in print for Church use (i.e. on physical notice boards and in-house presentations)

Yes, Images and media may be used in print for any public media (including but not limited to physical notice boards, Promotional material and newspapers)

Yes, Images and media may be used online in any public social media pages or websites (including but not limited to Emmanuel Uniting Church Social Media pages and websites)

No, Images and media may NOT be used in any circumstance

Date *

Signed (Name) *

Tip: Please type your name here in acknowledgment of form completion

Adult tent/caravan 2 nights 0

Personal Information

Please complete fields as appropriate for all adults and children who will be attending Church Camp 2026

First Name *

Last Name *

Preferred Name (for name tag) *

Gender *

Date of Birth *

Home Phone Number

Mobile Number

Email Address

Tip: of person who will manage registration and need to receive information about Holiday Club

Home Address

Home Address Line 2

Home Suburb

Home State

Home Postcode

Medical information

Please complete all fields as appropriate so that we can best care for you/your child/ren while in our care.

Do you have any Dietary Requirements, food or other Allergies? *

Details of Dietary Requirements & Allergies.

Tip: Please give as much detail as possible to allow caterers to provide for your needs

I will be at Church Camp...

Tip: Please provide as much detail about the times you will arrive and depart camp. i.e. arriving early Thursday, or only visiting for Saturday.

Do you have Anaphylaxis? *

Yes

No

Do you have Asthma? *

Yes

No

Details of Anaphylaxis, Asthma, Medical Conditions and other Care Needs (including custody arrangements if applicable)

Action Plan for Medical, Behavioral and Other Care Needs

Tip: Please forward documentation as required

Private Health Insurance

Private Health Insurance Provider

Private Health Insurance Member number

Medicare Number & Reference

Next of Kin & Emergency Contacts

Please list Next of Kin and at least one other person that we can contact should something happen to you while at Church Camp.

Next of Kin First Name

Next of Kin Last Name

Next of Kin Relationship

Next of Kin Phone Number

Emergency Contact 1 Name

Emergency Contact 1 Relationship

Emergency Contact 1 Phone Number

Emergency Contact 2 Name

Emergency Contact 2 Relationship

Emergency Contact 2 Phone Number

Privacy Statement, Consent, Indemnity, Photography and Media Release

Protecting your privacy is import to us. The information we seek allows us to manage risk, provide reasonable care and allow for your involvement in our program. We only ask for information that is necessary for managing the programs that you/ your child/ren are participating in and are careful to keep your information confidential and provide it only to those who require access to it for your care. If you have any questions about your information or how it is stored please contact the church office.

Release Statement *

At times the activities of Church Camp will be photographed, audio and or visually recorded. Do you give permission for Emmanuel Uniting Church to use photos or digital media taken by us which may identify yourself/ your child/ren? Note: Names identifying children will never be posted with images. Please read all 5 options here and tick those that you agree to. I consent to myself/my child/ren becoming a member of and taking part in the overall activities of Emmanuel Uniting Church. I confirm that I have provided details of any physical, mental or health conditions of myself/my child/ren which may impact upon their participation, or which has the potential to put them or any other person at risk. I confirm that I will advise the program coordinator and activity leader of any change of circumstances that would affect the care of myself/ my child/ren, their participation in the activity, or changes to the details of this form. I understand that if urgent medical attention is needed, every effort will be made to contact the persons listed on this form. In the event that they cannot be contacted in an emergency, I give my permission for myself/ my child/ren to receive medical treatment as deemed necessary by the leaders of the program/activity (including transport via Ambulance). Should this be necessary, I understand that I will be notified as soon as possible. I consent to information about myself/ my child/ren being collected and used for the running of activities and reporting of incidents and accidents.

At times the activities of Church Camp will be photographed, audio and or visually recorded. Do you give permission for Emmanuel Uniting Church to use photos or digital media taken by us which may identify yourself/ your child/ren?

Note: Names identifying children will never be posted with images.

Please read all 5 options here and tick those that you agree to.

Photography and Media Release *

Yes, Images and media may be used in print for Church use (i.e. on physical notice boards and in-house presentations)

Yes, Images and media may be used in print for any public media (including but not limited to physical notice boards, Promotional material and newspapers)

Yes, Images and media may be used online in any public social media pages or websites (including but not limited to Emmanuel Uniting Church Social Media pages and websites)

No, Images and media may NOT be used in any circumstance

Date *

Signed (Name) *

Tip: Please type your name here in acknowledgment of form completion

Child tent/caravan 1 night 0

Personal Information

Please complete fields as appropriate for all adults and children who will be attending Church Camp 2026

First Name *

Last Name *

Preferred Name (for name tag) *

Gender *

Date of Birth *

Home Phone Number

Mobile Number

Email Address

Tip: of person who will manage registration and need to receive information about Holiday Club

Home Address

Home Address Line 2

Home Suburb

Home State

Home Postcode

Medical information

Please complete all fields as appropriate so that we can best care for you/your child/ren while in our care.

Do you have any Dietary Requirements, food or other Allergies? *

Details of Dietary Requirements & Allergies.

Tip: Please give as much detail as possible to allow caterers to provide for your needs

I will be at Church Camp...

Tip: Please provide as much detail about the times you will arrive and depart camp. i.e. arriving early Thursday, or only visiting for Saturday.

Do you have Anaphylaxis? *

Yes

No

Do you have Asthma? *

Yes

No

Details of Anaphylaxis, Asthma, Medical Conditions and other Care Needs (including custody arrangements if applicable)

Action Plan for Medical, Behavioral and Other Care Needs

Tip: Please forward documentation as required

Private Health Insurance

Private Health Insurance Provider

Private Health Insurance Member number

Medicare Number & Reference

Next of Kin & Emergency Contacts

Please list Next of Kin and at least one other person that we can contact should something happen to you while at Church Camp.

Next of Kin First Name

Next of Kin Last Name

Next of Kin Relationship

Next of Kin Phone Number

Emergency Contact 1 Name

Emergency Contact 1 Relationship

Emergency Contact 1 Phone Number

Emergency Contact 2 Name

Emergency Contact 2 Relationship

Emergency Contact 2 Phone Number

Privacy Statement, Consent, Indemnity, Photography and Media Release

Protecting your privacy is import to us. The information we seek allows us to manage risk, provide reasonable care and allow for your involvement in our program. We only ask for information that is necessary for managing the programs that you/ your child/ren are participating in and are careful to keep your information confidential and provide it only to those who require access to it for your care. If you have any questions about your information or how it is stored please contact the church office.

Release Statement *

At times the activities of Church Camp will be photographed, audio and or visually recorded. Do you give permission for Emmanuel Uniting Church to use photos or digital media taken by us which may identify yourself/ your child/ren? Note: Names identifying children will never be posted with images. Please read all 5 options here and tick those that you agree to. I consent to myself/my child/ren becoming a member of and taking part in the overall activities of Emmanuel Uniting Church. I confirm that I have provided details of any physical, mental or health conditions of myself/my child/ren which may impact upon their participation, or which has the potential to put them or any other person at risk. I confirm that I will advise the program coordinator and activity leader of any change of circumstances that would affect the care of myself/ my child/ren, their participation in the activity, or changes to the details of this form. I understand that if urgent medical attention is needed, every effort will be made to contact the persons listed on this form. In the event that they cannot be contacted in an emergency, I give my permission for myself/ my child/ren to receive medical treatment as deemed necessary by the leaders of the program/activity (including transport via Ambulance). Should this be necessary, I understand that I will be notified as soon as possible. I consent to information about myself/ my child/ren being collected and used for the running of activities and reporting of incidents and accidents.

At times the activities of Church Camp will be photographed, audio and or visually recorded. Do you give permission for Emmanuel Uniting Church to use photos or digital media taken by us which may identify yourself/ your child/ren?

Note: Names identifying children will never be posted with images.

Please read all 5 options here and tick those that you agree to.

Photography and Media Release *

Yes, Images and media may be used in print for Church use (i.e. on physical notice boards and in-house presentations)

Yes, Images and media may be used in print for any public media (including but not limited to physical notice boards, Promotional material and newspapers)

Yes, Images and media may be used online in any public social media pages or websites (including but not limited to Emmanuel Uniting Church Social Media pages and websites)

No, Images and media may NOT be used in any circumstance

Date *

Signed (Name) *

Tip: Please type your name here in acknowledgment of form completion

Child tent/caravan 2 nights 0

Personal Information

Please complete fields as appropriate for all adults and children who will be attending Church Camp 2026

First Name *

Last Name *

Preferred Name (for name tag) *

Gender *

Date of Birth *

Home Phone Number

Mobile Number

Email Address

Tip: of person who will manage registration and need to receive information about Holiday Club

Home Address

Home Address Line 2

Home Suburb

Home State

Home Postcode

Medical information

Please complete all fields as appropriate so that we can best care for you/your child/ren while in our care.

Do you have any Dietary Requirements, food or other Allergies? *

Details of Dietary Requirements & Allergies.

Tip: Please give as much detail as possible to allow caterers to provide for your needs

I will be at Church Camp...

Tip: Please provide as much detail about the times you will arrive and depart camp. i.e. arriving early Thursday, or only visiting for Saturday.

Do you have Anaphylaxis? *

Yes

No

Do you have Asthma? *

Yes

No

Details of Anaphylaxis, Asthma, Medical Conditions and other Care Needs (including custody arrangements if applicable)

Action Plan for Medical, Behavioral and Other Care Needs

Tip: Please forward documentation as required

Private Health Insurance

Private Health Insurance Provider

Private Health Insurance Member number

Medicare Number & Reference

Next of Kin & Emergency Contacts

Please list Next of Kin and at least one other person that we can contact should something happen to you while at Church Camp.

Next of Kin First Name

Next of Kin Last Name

Next of Kin Relationship

Next of Kin Phone Number

Emergency Contact 1 Name

Emergency Contact 1 Relationship

Emergency Contact 1 Phone Number

Emergency Contact 2 Name

Emergency Contact 2 Relationship

Emergency Contact 2 Phone Number

Privacy Statement, Consent, Indemnity, Photography and Media Release

Protecting your privacy is import to us. The information we seek allows us to manage risk, provide reasonable care and allow for your involvement in our program. We only ask for information that is necessary for managing the programs that you/ your child/ren are participating in and are careful to keep your information confidential and provide it only to those who require access to it for your care. If you have any questions about your information or how it is stored please contact the church office.

Release Statement *

At times the activities of Church Camp will be photographed, audio and or visually recorded. Do you give permission for Emmanuel Uniting Church to use photos or digital media taken by us which may identify yourself/ your child/ren? Note: Names identifying children will never be posted with images. Please read all 5 options here and tick those that you agree to. I consent to myself/my child/ren becoming a member of and taking part in the overall activities of Emmanuel Uniting Church. I confirm that I have provided details of any physical, mental or health conditions of myself/my child/ren which may impact upon their participation, or which has the potential to put them or any other person at risk. I confirm that I will advise the program coordinator and activity leader of any change of circumstances that would affect the care of myself/ my child/ren, their participation in the activity, or changes to the details of this form. I understand that if urgent medical attention is needed, every effort will be made to contact the persons listed on this form. In the event that they cannot be contacted in an emergency, I give my permission for myself/ my child/ren to receive medical treatment as deemed necessary by the leaders of the program/activity (including transport via Ambulance). Should this be necessary, I understand that I will be notified as soon as possible. I consent to information about myself/ my child/ren being collected and used for the running of activities and reporting of incidents and accidents.

At times the activities of Church Camp will be photographed, audio and or visually recorded. Do you give permission for Emmanuel Uniting Church to use photos or digital media taken by us which may identify yourself/ your child/ren?

Note: Names identifying children will never be posted with images.

Please read all 5 options here and tick those that you agree to.

Photography and Media Release *

Yes, Images and media may be used in print for Church use (i.e. on physical notice boards and in-house presentations)

Yes, Images and media may be used in print for any public media (including but not limited to physical notice boards, Promotional material and newspapers)

Yes, Images and media may be used online in any public social media pages or websites (including but not limited to Emmanuel Uniting Church Social Media pages and websites)

No, Images and media may NOT be used in any circumstance

Date *

Signed (Name) *

Tip: Please type your name here in acknowledgment of form completion

Adult cabin 1 night 0

Personal Information

Please complete fields as appropriate for all adults and children who will be attending Church Camp 2026

First Name *

Last Name *

Preferred Name (for name tag) *

Gender *

Date of Birth *

Home Phone Number

Mobile Number

Email Address

Tip: of person who will manage registration and need to receive information about Holiday Club

Home Address

Home Address Line 2

Home Suburb

Home State

Home Postcode

Medical information

Please complete all fields as appropriate so that we can best care for you/your child/ren while in our care.

Do you have any Dietary Requirements, food or other Allergies? *

Details of Dietary Requirements & Allergies.

Tip: Please give as much detail as possible to allow caterers to provide for your needs

I will be at Church Camp...

Tip: Please provide as much detail about the times you will arrive and depart camp. i.e. arriving early Thursday, or only visiting for Saturday.

Do you have Anaphylaxis? *

Yes

No

Do you have Asthma? *

Yes

No

Details of Anaphylaxis, Asthma, Medical Conditions and other Care Needs (including custody arrangements if applicable)

Action Plan for Medical, Behavioral and Other Care Needs

Tip: Please forward documentation as required

Private Health Insurance

Private Health Insurance Provider

Private Health Insurance Member number

Medicare Number & Reference

Next of Kin & Emergency Contacts

Please list Next of Kin and at least one other person that we can contact should something happen to you while at Church Camp.

Next of Kin First Name

Next of Kin Last Name

Next of Kin Relationship

Next of Kin Phone Number

Emergency Contact 1 Name

Emergency Contact 1 Relationship

Emergency Contact 1 Phone Number

Emergency Contact 2 Name

Emergency Contact 2 Relationship

Emergency Contact 2 Phone Number

Privacy Statement, Consent, Indemnity, Photography and Media Release

Protecting your privacy is import to us. The information we seek allows us to manage risk, provide reasonable care and allow for your involvement in our program. We only ask for information that is necessary for managing the programs that you/ your child/ren are participating in and are careful to keep your information confidential and provide it only to those who require access to it for your care. If you have any questions about your information or how it is stored please contact the church office.

Release Statement *

At times the activities of Church Camp will be photographed, audio and or visually recorded. Do you give permission for Emmanuel Uniting Church to use photos or digital media taken by us which may identify yourself/ your child/ren? Note: Names identifying children will never be posted with images. Please read all 5 options here and tick those that you agree to. I consent to myself/my child/ren becoming a member of and taking part in the overall activities of Emmanuel Uniting Church. I confirm that I have provided details of any physical, mental or health conditions of myself/my child/ren which may impact upon their participation, or which has the potential to put them or any other person at risk. I confirm that I will advise the program coordinator and activity leader of any change of circumstances that would affect the care of myself/ my child/ren, their participation in the activity, or changes to the details of this form. I understand that if urgent medical attention is needed, every effort will be made to contact the persons listed on this form. In the event that they cannot be contacted in an emergency, I give my permission for myself/ my child/ren to receive medical treatment as deemed necessary by the leaders of the program/activity (including transport via Ambulance). Should this be necessary, I understand that I will be notified as soon as possible. I consent to information about myself/ my child/ren being collected and used for the running of activities and reporting of incidents and accidents.

At times the activities of Church Camp will be photographed, audio and or visually recorded. Do you give permission for Emmanuel Uniting Church to use photos or digital media taken by us which may identify yourself/ your child/ren?

Note: Names identifying children will never be posted with images.

Please read all 5 options here and tick those that you agree to.

Photography and Media Release *

Yes, Images and media may be used in print for Church use (i.e. on physical notice boards and in-house presentations)

Yes, Images and media may be used in print for any public media (including but not limited to physical notice boards, Promotional material and newspapers)

Yes, Images and media may be used online in any public social media pages or websites (including but not limited to Emmanuel Uniting Church Social Media pages and websites)

No, Images and media may NOT be used in any circumstance

Date *

Signed (Name) *

Tip: Please type your name here in acknowledgment of form completion

Adult cabin 2 night 0

Personal Information

Please complete fields as appropriate for all adults and children who will be attending Church Camp 2026

First Name *

Last Name *

Preferred Name (for name tag) *

Gender *

Date of Birth *

Home Phone Number

Mobile Number

Email Address

Tip: of person who will manage registration and need to receive information about Holiday Club

Home Address

Home Address Line 2

Home Suburb

Home State

Home Postcode

Medical information

Please complete all fields as appropriate so that we can best care for you/your child/ren while in our care.

Do you have any Dietary Requirements, food or other Allergies? *

Details of Dietary Requirements & Allergies.

Tip: Please give as much detail as possible to allow caterers to provide for your needs

I will be at Church Camp...

Tip: Please provide as much detail about the times you will arrive and depart camp. i.e. arriving early Thursday, or only visiting for Saturday.

Do you have Anaphylaxis? *

Yes

No

Do you have Asthma? *

Yes

No

Details of Anaphylaxis, Asthma, Medical Conditions and other Care Needs (including custody arrangements if applicable)

Action Plan for Medical, Behavioral and Other Care Needs

Tip: Please forward documentation as required

Private Health Insurance

Private Health Insurance Provider

Private Health Insurance Member number

Medicare Number & Reference

Next of Kin & Emergency Contacts

Please list Next of Kin and at least one other person that we can contact should something happen to you while at Church Camp.

Next of Kin First Name

Next of Kin Last Name

Next of Kin Relationship

Next of Kin Phone Number

Emergency Contact 1 Name

Emergency Contact 1 Relationship

Emergency Contact 1 Phone Number

Emergency Contact 2 Name

Emergency Contact 2 Relationship

Emergency Contact 2 Phone Number

Privacy Statement, Consent, Indemnity, Photography and Media Release

Protecting your privacy is import to us. The information we seek allows us to manage risk, provide reasonable care and allow for your involvement in our program. We only ask for information that is necessary for managing the programs that you/ your child/ren are participating in and are careful to keep your information confidential and provide it only to those who require access to it for your care. If you have any questions about your information or how it is stored please contact the church office.

Release Statement *

At times the activities of Church Camp will be photographed, audio and or visually recorded. Do you give permission for Emmanuel Uniting Church to use photos or digital media taken by us which may identify yourself/ your child/ren? Note: Names identifying children will never be posted with images. Please read all 5 options here and tick those that you agree to. I consent to myself/my child/ren becoming a member of and taking part in the overall activities of Emmanuel Uniting Church. I confirm that I have provided details of any physical, mental or health conditions of myself/my child/ren which may impact upon their participation, or which has the potential to put them or any other person at risk. I confirm that I will advise the program coordinator and activity leader of any change of circumstances that would affect the care of myself/ my child/ren, their participation in the activity, or changes to the details of this form. I understand that if urgent medical attention is needed, every effort will be made to contact the persons listed on this form. In the event that they cannot be contacted in an emergency, I give my permission for myself/ my child/ren to receive medical treatment as deemed necessary by the leaders of the program/activity (including transport via Ambulance). Should this be necessary, I understand that I will be notified as soon as possible. I consent to information about myself/ my child/ren being collected and used for the running of activities and reporting of incidents and accidents.

At times the activities of Church Camp will be photographed, audio and or visually recorded. Do you give permission for Emmanuel Uniting Church to use photos or digital media taken by us which may identify yourself/ your child/ren?

Note: Names identifying children will never be posted with images.

Please read all 5 options here and tick those that you agree to.

Photography and Media Release *

Yes, Images and media may be used in print for Church use (i.e. on physical notice boards and in-house presentations)

Yes, Images and media may be used in print for any public media (including but not limited to physical notice boards, Promotional material and newspapers)

Yes, Images and media may be used online in any public social media pages or websites (including but not limited to Emmanuel Uniting Church Social Media pages and websites)

No, Images and media may NOT be used in any circumstance

Date *

Signed (Name) *

Tip: Please type your name here in acknowledgment of form completion

Child cabin 1 night 0

Personal Information

Please complete fields as appropriate for all adults and children who will be attending Church Camp 2026

First Name *

Last Name *

Preferred Name (for name tag) *

Gender *

Date of Birth *

Home Phone Number

Mobile Number

Email Address

Tip: of person who will manage registration and need to receive information about Holiday Club

Home Address

Home Address Line 2

Home Suburb

Home State

Home Postcode

Medical information

Please complete all fields as appropriate so that we can best care for you/your child/ren while in our care.

Do you have any Dietary Requirements, food or other Allergies? *

Details of Dietary Requirements & Allergies.

Tip: Please give as much detail as possible to allow caterers to provide for your needs

I will be at Church Camp...

Tip: Please provide as much detail about the times you will arrive and depart camp. i.e. arriving early Thursday, or only visiting for Saturday.

Do you have Anaphylaxis? *

Yes

No

Do you have Asthma? *

Yes

No

Details of Anaphylaxis, Asthma, Medical Conditions and other Care Needs (including custody arrangements if applicable)

Action Plan for Medical, Behavioral and Other Care Needs

Tip: Please forward documentation as required

Private Health Insurance

Private Health Insurance Provider

Private Health Insurance Member number

Medicare Number & Reference

Next of Kin & Emergency Contacts

Please list Next of Kin and at least one other person that we can contact should something happen to you while at Church Camp.

Next of Kin First Name

Next of Kin Last Name

Next of Kin Relationship

Next of Kin Phone Number

Emergency Contact 1 Name

Emergency Contact 1 Relationship

Emergency Contact 1 Phone Number

Emergency Contact 2 Name

Emergency Contact 2 Relationship

Emergency Contact 2 Phone Number

Privacy Statement, Consent, Indemnity, Photography and Media Release

Protecting your privacy is import to us. The information we seek allows us to manage risk, provide reasonable care and allow for your involvement in our program. We only ask for information that is necessary for managing the programs that you/ your child/ren are participating in and are careful to keep your information confidential and provide it only to those who require access to it for your care. If you have any questions about your information or how it is stored please contact the church office.

Release Statement *

At times the activities of Church Camp will be photographed, audio and or visually recorded. Do you give permission for Emmanuel Uniting Church to use photos or digital media taken by us which may identify yourself/ your child/ren? Note: Names identifying children will never be posted with images. Please read all 5 options here and tick those that you agree to. I consent to myself/my child/ren becoming a member of and taking part in the overall activities of Emmanuel Uniting Church. I confirm that I have provided details of any physical, mental or health conditions of myself/my child/ren which may impact upon their participation, or which has the potential to put them or any other person at risk. I confirm that I will advise the program coordinator and activity leader of any change of circumstances that would affect the care of myself/ my child/ren, their participation in the activity, or changes to the details of this form. I understand that if urgent medical attention is needed, every effort will be made to contact the persons listed on this form. In the event that they cannot be contacted in an emergency, I give my permission for myself/ my child/ren to receive medical treatment as deemed necessary by the leaders of the program/activity (including transport via Ambulance). Should this be necessary, I understand that I will be notified as soon as possible. I consent to information about myself/ my child/ren being collected and used for the running of activities and reporting of incidents and accidents.

At times the activities of Church Camp will be photographed, audio and or visually recorded. Do you give permission for Emmanuel Uniting Church to use photos or digital media taken by us which may identify yourself/ your child/ren?

Note: Names identifying children will never be posted with images.

Please read all 5 options here and tick those that you agree to.

Photography and Media Release *

Yes, Images and media may be used in print for Church use (i.e. on physical notice boards and in-house presentations)

Yes, Images and media may be used in print for any public media (including but not limited to physical notice boards, Promotional material and newspapers)

Yes, Images and media may be used online in any public social media pages or websites (including but not limited to Emmanuel Uniting Church Social Media pages and websites)

No, Images and media may NOT be used in any circumstance

Date *

Signed (Name) *

Tip: Please type your name here in acknowledgment of form completion

Child cabin 2 nights 0

Personal Information

Please complete fields as appropriate for all adults and children who will be attending Church Camp 2026

First Name *

Last Name *

Preferred Name (for name tag) *

Gender *

Date of Birth *

Home Phone Number

Mobile Number

Email Address

Tip: of person who will manage registration and need to receive information about Holiday Club

Home Address

Home Address Line 2

Home Suburb

Home State

Home Postcode

Medical information

Please complete all fields as appropriate so that we can best care for you/your child/ren while in our care.

Do you have any Dietary Requirements, food or other Allergies? *

Details of Dietary Requirements & Allergies.

Tip: Please give as much detail as possible to allow caterers to provide for your needs

I will be at Church Camp...

Tip: Please provide as much detail about the times you will arrive and depart camp. i.e. arriving early Thursday, or only visiting for Saturday.

Do you have Anaphylaxis? *

Yes

No

Do you have Asthma? *

Yes

No

Details of Anaphylaxis, Asthma, Medical Conditions and other Care Needs (including custody arrangements if applicable)

Action Plan for Medical, Behavioral and Other Care Needs

Tip: Please forward documentation as required

Private Health Insurance

Private Health Insurance Provider

Private Health Insurance Member number

Medicare Number & Reference

Next of Kin & Emergency Contacts

Please list Next of Kin and at least one other person that we can contact should something happen to you while at Church Camp.

Next of Kin First Name

Next of Kin Last Name

Next of Kin Relationship

Next of Kin Phone Number

Emergency Contact 1 Name

Emergency Contact 1 Relationship

Emergency Contact 1 Phone Number

Emergency Contact 2 Name

Emergency Contact 2 Relationship

Emergency Contact 2 Phone Number

Privacy Statement, Consent, Indemnity, Photography and Media Release

Protecting your privacy is import to us. The information we seek allows us to manage risk, provide reasonable care and allow for your involvement in our program. We only ask for information that is necessary for managing the programs that you/ your child/ren are participating in and are careful to keep your information confidential and provide it only to those who require access to it for your care. If you have any questions about your information or how it is stored please contact the church office.

Release Statement *

At times the activities of Church Camp will be photographed, audio and or visually recorded. Do you give permission for Emmanuel Uniting Church to use photos or digital media taken by us which may identify yourself/ your child/ren? Note: Names identifying children will never be posted with images. Please read all 5 options here and tick those that you agree to. I consent to myself/my child/ren becoming a member of and taking part in the overall activities of Emmanuel Uniting Church. I confirm that I have provided details of any physical, mental or health conditions of myself/my child/ren which may impact upon their participation, or which has the potential to put them or any other person at risk. I confirm that I will advise the program coordinator and activity leader of any change of circumstances that would affect the care of myself/ my child/ren, their participation in the activity, or changes to the details of this form. I understand that if urgent medical attention is needed, every effort will be made to contact the persons listed on this form. In the event that they cannot be contacted in an emergency, I give my permission for myself/ my child/ren to receive medical treatment as deemed necessary by the leaders of the program/activity (including transport via Ambulance). Should this be necessary, I understand that I will be notified as soon as possible. I consent to information about myself/ my child/ren being collected and used for the running of activities and reporting of incidents and accidents.

At times the activities of Church Camp will be photographed, audio and or visually recorded. Do you give permission for Emmanuel Uniting Church to use photos or digital media taken by us which may identify yourself/ your child/ren?

Note: Names identifying children will never be posted with images.

Please read all 5 options here and tick those that you agree to.

Photography and Media Release *

Yes, Images and media may be used in print for Church use (i.e. on physical notice boards and in-house presentations)

Yes, Images and media may be used in print for any public media (including but not limited to physical notice boards, Promotional material and newspapers)

Yes, Images and media may be used online in any public social media pages or websites (including but not limited to Emmanuel Uniting Church Social Media pages and websites)

No, Images and media may NOT be used in any circumstance

Date *

Signed (Name) *

Tip: Please type your name here in acknowledgment of form completion

Emmanuel Church Camp 2026

Click on the REGISTER NOW button above the map to proceed to register (also at bottom of this page).

What is this Camp:

What next?

Date & Time

Adult Day visitor 0

Personal Information

Medical information

Next of Kin & Emergency Contacts

Privacy Statement, Consent, Indemnity, Photography and Media Release

Child Day visitor 0

Personal Information

Medical information

Next of Kin & Emergency Contacts

Privacy Statement, Consent, Indemnity, Photography and Media Release

Adult tent/caravan 1 night 0

Personal Information

Medical information

Next of Kin & Emergency Contacts

Privacy Statement, Consent, Indemnity, Photography and Media Release

Adult tent/caravan 2 nights 0

Personal Information

Medical information

Next of Kin & Emergency Contacts

Privacy Statement, Consent, Indemnity, Photography and Media Release

Child tent/caravan 1 night 0

Personal Information

Medical information

Next of Kin & Emergency Contacts

Privacy Statement, Consent, Indemnity, Photography and Media Release

Child tent/caravan 2 nights 0

Personal Information

Medical information

Next of Kin & Emergency Contacts

Privacy Statement, Consent, Indemnity, Photography and Media Release

Adult cabin 1 night 0

Personal Information

Medical information

Next of Kin & Emergency Contacts

Privacy Statement, Consent, Indemnity, Photography and Media Release

Adult cabin 2 night 0

Personal Information

Medical information

Next of Kin & Emergency Contacts

Privacy Statement, Consent, Indemnity, Photography and Media Release

Child cabin 1 night 0

Personal Information

Medical information

Next of Kin & Emergency Contacts

Privacy Statement, Consent, Indemnity, Photography and Media Release

Child cabin 2 nights 0

Personal Information

Medical information

Next of Kin & Emergency Contacts

Privacy Statement, Consent, Indemnity, Photography and Media Release