Camp Hohepa Registration Form – Parents or Guardians please print this form out , complete and then return to 'Camp Hohepa Inc P.O.Box 43 Snells Beach 0942 Rodney' along with your $20 Deposit (You can pay the whole fee if you like).
Child’s full name:…………………………………………………………………………..
Parent’s names:…………………………………………………………………………….
Address:……………………………………………………………………………………..
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Child’s Date of Birth / /19 Lifejacket size: XS – S – M - L – XL - XXL (circle 1)
Contact details for parents:
Home: Mob: Work:
Close relative if parents can’t be contacted in case of emergency:
Name:……………………………………………………………………………………..
Contact: Home Mob Work:
Does your child have any medical problem or affliction: Yes / No If yes please describe:
…………………………………………………………………………………………………..
Is you child allergic to anything including food: Yes / No If yes please describe:
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Is there any food your child won’t or shouldn’t eat? Yes / No If yes please describe:
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Does you child have a bedwetting problem? Yes / No
Please supply the organisers with all medication doses and other relevant medical advice about your child at the time of dropping him or her off at the Camp.
Please sign below that you agree to allow your child to attend Camp Hohepa. You also agree to remove him from the camp if he is considered to have a disruptive influence on his fellow campers, or in any way behaves in a manner that is considered unacceptable by the organisers.
Signed: date: