1. 5th-7th October
Camper Details:
Name:
Date of Birth:
Address:
Home Phone:
Cell Number:
E-mail:
Camper Signature:
M:
$80
F:
Emergency Details:
Caregiver Name:
Contact Number:
E-mail:
Medical Requirements/Other:
Disclaimer:
While all care is taken by KHAOS (Burnside Elim Community Church Youth
Group) we accept no liability for any loss, injury or damage to your property or
person, whether arising through our negligence or otherwise. By signing this
form, you agree to obey the camp rules as noted on the letter to parents; to tell
us if you can’t participate in any activity or if there is anything (such as illness
or injury) which may affect our decision to allow you to participate in any
activity; or not do anything which may put yourself or others at risk of harm.
Caregiver Signature:
Burnside Elim Community Church
193 Grahams Road, Burnside, Christchurch
Phone: (03) 358 4486
E-Mail: onlinekhaos@gmail.com
