Online Registraton Form

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Registrations have now closed       Please complete the form below to register (one household per form: not to be used for group registrations) Enter the details of a parent/guardian for the household in this registration: First name: Last name: Address: Phone: Email: Additional emergency contact  phone during camp week:     Church attended: Please select None Covenant Grace Baptist Church, Timaru Crosspoint Church, Palmerston North Emmanuel Church, Auckland Grace Bapist Church, Christchurch Gracenet Community Church, Wellington Rolleston Baptist Church, Rolleston Shore Baptist Church, Auckland South City Church, Auckland Trinity Reformed Baptist Church, Hamilton West Church New Lynn, Auckland Other (please enter the church name and location below)   Enter the details for the first person in this household registration: First Name: Last Name: Date of Birth: Gender: M F Fee: Dietary needs: Health awareness: Other information: By submitting this registration you confirm that this camper agrees to the Code of Conduct Enter the details for the second person in this household registration: First Name: Last Name: Date of Birth: Gender: M F Fee: Dietary needs: Health awareness: Other information: By submitting this registration you confirm that this camper agrees to the Code of Conduct Enter the details for the third person in this household registration: First Name: Last Name: Date of Birth: Gender: M F Fee: Dietary needs: Health awareness: Other information: By submitting this registration you confirm that this camper agrees to the Code of Conduct Enter the details for the fourth person in this household registration: First Name: Last Name: Date of Birth: Gender: M F Fee: Dietary needs: Health awareness: Other information: By submitting this registration you confirm that this camper agrees to the Code of Conduct Enter the details for the fifth person in this household registration: First Name: Last Name: Date of Birth: Gender: M F Fee: Dietary needs: Health awareness: Other information: By submitting this registration you confirm that this camper agrees to the Code of Conduct Enter the details for the sixth person in this household registration: First Name: Last Name: Date of Birth: Gender: M F Fee: Dietary needs: Health awareness: Other information: By submitting this registration you confirm that this camper agrees to the Code of Conduct Enter the details for the seventh person in this household registration: First Name: Last Name: Date of Birth: Gender: M F Fee: Dietary needs: Health awareness: Other information: By submitting this registration you confirm that this camper agrees to the Code of Conduct Enter the details for the eighth person in this household registration: First Name: Last Name: Date of Birth: Gender: M F Fee: Dietary needs: Health awareness: Other information: By submitting this registration you confirm that this camper agrees to the Code of Conduct Enter the details for the ninth person in this household registration: First Name: Last Name: Date of Birth: Gender: M F Fee: Dietary needs: Health awareness: Other information: By submitting this registration you confirm that this camper agrees to the Code of Conduct Enter the details for the tenth person in this household registration: First Name: Last Name: Date of Birth: Gender: M F Fee: Dietary needs: Health awareness: Other information: By submitting this registration you confirm that this camper agrees to the Code of Conduct Enter the details for the eleventh person in this household registration: First Name: Last Name: Date of Birth: Gender: M F Fee: Dietary needs: Health awareness: Other information: By submitting this registration you confirm that this camper agrees to the Code of Conduct Enter the details for the twelfth person in this household registration: First Name: Last Name: Date of Birth: Gender: M F Fee: Dietary needs: Health awareness: Other information: By submitting this registration you confirm that this camper agrees to the Code of Conduct   TOTAL registration fee: $ Payment by: Direct Credit NZ Credit Card via PayPal Payment processing fee: $   TOTAL amount due: $ Cancellations & Refunds: If you cancel any time BEFORE the closing date for registrations then a full refund will be provided. If cancelling after the closing date but before the first day of camp then a 50% refund will be given. If you cancel on or after the first day of camp there will be NO refund. The closing date for registering for this year's camp is 25th March 2024. The parent/guardian detailed at the top of this registration page has read and agrees to the content of the Activity Consent Form for each of the campers registered above Optional Message: In submitting this registration you agree that the information supplied here is accurate and that it may be used as appropriate in relation to this Youth Camp. The information (whether printed or in electronic form) will remain private and confidential and will be destroyed and/or deleted at the conclusion of the camp. Names and email addresses will be added to a Youth Camp mailing list with the option to unsubscribe at any time.

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