Youth Camp-The Great Escape

Registration Type *

Student Registration

Leader Registration

I require assistance with payment.

Yes

No

First Name *

Middle Name

Last Name *

Gender *

Date of Birth *

School Year *

Phone Number

Home Address

Home Address Line 2

Home City

Home State

Postcode

Which youth group do you lead with?

What youth group does your child attend?

Lighthouse Youth

New Vine Beaches

Belmont Baptist

Other

If you selected 'other' Youth Group please specify.

If possible my child would like to share a room with these people/person. Please list the other child's name and youth group.

Tip: If your child does not know anyone attending they will be placed with people of a similar age.

Accommodation

Cabin

Tent/Swag

Not staying the night

Emergency Contact 1 *

Emergency Number 1 *

Emergency Contact 2 *

Emergency Number 2 *

I give permission for the following medications to be administered by a youth leader in the event that my child requires them. *

Panadol/Paracetamol

lbuprofen/Nurofen

None

Please list any medical conditions or allergies, and any medication or special care your child requires. If your child is anaphylactic to anything please provide information regarding EpiPen and management plan.

Please list any allergies or dietary requirements that our kitchen needs to know about.

Please include any diagnosis, disabilities, or concerns that you feel would be appropriate for the leaders to know, so our team can care for your young person to the best of their ability.

What are your child's dietary requirements.

Parent Authority *

I accept responsibility for my child as soon as the program is finished.

I authorise the leader in charge to arrange for my child to receive such first aid and medical treatment as a trained first aid person may deem necessary.

I authorise the use of calling an ambulance in emergency.

I accept responsibility for payment of all expenses associated with such treatment.

My child is not allowed to use manual (non electronic) tools.

True

False

Water activity declaration *

Non-swimmer: My child is not able to swim.

Weak swimmer: My child is not a confident swimmer or is not comfortable in the water.

Average swimmer: My child is a reasonable swimmer but is not very strong or confident in deep water.

Strong swimmer: My child is a strong swimmer and is very confident in deep water.

I consent to my child participating in water-based activities. *

Yes

No

Transport and Photography

I DO NOT give permission for my child to be transported in private cars arranged by the leaders of the group. This is unlikely and will only occur in an emergency.

I DO NOT give permission for my child to receive transport on the youth bus.

I DO NOT permit photos or videos where my childs face appears to be displayed in church publications, e.g. website, newsletters, brochures, etc.

I DO NOT permit photos or videos where my childs face appears to be used in Youth Group/Church social media posts.

Transport authority: If I am unable to collect my child at the finishing time they may be transported home from the program with the following people:

Parent completing form (Name in Full)

Parent Email Address

Tip: The packing list and any extra information will be sent to this email address

Date form completed

Student 0

Lighthouse Youth Camp 2026

General Information

Emergency Contacts

Medical Information

Parent Declarations

Leader 0

Lighthouse Youth Camp 2026

General Information

Emergency Contacts

Medical Information

Parent Declarations