Camp Sign Up

Child

General

Child Full Name (required)

Sex (required)
MaleFemaleOther

School (required)

Year level in 2021 (required)
23456789101112

Child Mobile Phone

Religious Preference

Medical

Date of Birth (YY-MM-DD) (required)

Medicare Number (required)

Ambulance Subscriber Number

Private Health Fund

Private Health Fund Number

Dietary Requirements - All meals prepared for participants is kosher (required)
NoneVegetarianVeganLactose FreeGluten FreeOther

Other:

Allergies:

Other Comments:

Can the Child take Paracetamol in case of pain or fever? (required)
Yes (2 Tablets)Yes (1 Tablet)No

Does the Child take any regular medication? (required)
YesNo

Medication:

Medication Dosage:

Medication Frequency:

Does the Child Self Medicate? (required)
YesNo

Does the Child have any Medical History?:
AnemiaAnaphylaxis (Send Plan)Asthma (Send Plan)DiabetesEpilepsyGastric DiseaseHeart ConditionEating DisorderHerniaKidney DiseaseLiver DiseaseMental IllnessOperationsSleeping DisorderOther

Details:

Does your child have any dietary habits that could possibly prevent them from consuming particular
foods/meals (e.g. eats small portions or hates broccoli), If so please specify.
We cannot guarantee that these preferences will be fulfilled, however we will take them into consideration.

Last Tetanus Injection (YY-MM-DD) (required)

Is the Camper Fully Immunized according to the NHMRC schedule? (required)
YesNo

First Child's Mental Health and Disabilities?

Please note: It is imperative that you disclose any and all information about your child’s mental health to us as this will greatly improve the wellbeing of your child on camp and our ability to cater to them. If this information is not disclosed, it may inhibit our ability to care for them correctly. This information will be kept completely confidential within the appropriate carers

DepressionAnxiety/Panic DisordersObsessive Compulsive DisorderADDADHDAutism Spectrum (Please Specify)Pervasive Developemental DisorderBipolarAnorexiaBulimiaBinge EatingAsperger's SyndromeNotable PhobiasOther

Details:

Does your child have any behavioural issues including but not limited to: Oppositional Defiance Disorder, difficulty with authority, aggressive tendencies, overstimulation or other: (required)
YesNo

Details:

Does your child have any other physical or mental disabilities that we should be aware of: (required)
YesNo

Details:

If you would like to be contacted before camp to provide further explanations and actions plans for your child please tick this box
YesNo

General Info

Full Address (required)

Family Doctor's Name

Family Doctor's Phone

First Guardian

First Parent/Guardian Full Name (required)

First Parent/Guardian Email (required)

First Parent/Guardian Mobile Phone (required)

First Parent/Guardian Home Phone (required)

Relation to Camper (required)
MotherFatherGuardianOther

Second Guardian

Second Parent/Guardian Full Name

Second Parent/Guardian Email

Second Parent/Guardian Mobile Phone

Second Parent/Guardian Home Phone

Relation to Camper
MotherFatherGuardianOther

Emergency Contact

Emergency Contact Full Name (required)

Emergency Contact Email (required)

Emergency Contact Mobile Phone (required)

Emergency Contact Home Phone (required)

Relation to Camper (required)

Indemnity form

By filling the boxes below, you are agreeing to all details on the Betar Australia Indemnity Form as of the date you are currently signing

Signature of Participant (required)

Signature of Parent/Guardian (required)

A copy of the completed indemnity form will be sent to the email you input as the "First Parent/Guardian Email" as well as our own records once you click send. If you have any issues please contact us here