Register Form - Boys to the bush

Choose the program

Program Type *

Please contact a member of our staff before completing this form to secure your place within one of our programs.

Participant Details

Participant *

First

Last

Date of Birth *

Gender *

Does the Participant identify as Aboriginal or Torres Strait Islander? *

Address *

City *

State *

Postcode *

School Grade *

Name of School *

I consent to Boys To The Bush contacting the participants school through reports, verbal or written communication. *

Yes
No

This allows Boys to the Bush to keep the participants school informed of their involvement with us.

Participant Medicare Number *

Medicare Individual Reference Number *

Medicare Expiry Date *

Health Conditions and Medical Details

Please list any Health Conditions *

Additional information about Health Conditions including details of medications/dosage requirements.

Please give us as much information as possible to help us give the participant the best experience across our programs

Guardian/Caseworker Contact Information

Parent / Carer Name *

First

Last

Relationship to Participant *

Address (if different from above)

Mobile Number *

Email *

Case Worker Name (If Applicable)

First

Last

Case Worker Phone Number (If Applicable)

Case Worker Email (If Applicable)

Emergency Contact Name *

First

Last

Relationship to Participant *

Contact Number *

Consent and Information to Help Us

I consent to Boys to the Bush taking photos and/or video footage of the Participant whilst on the camp. *

Yes
No

I consent to Boys to the Bush using these images and footage to be uploaded to a Photo Gallery on their website and/or Social Media Pages. *

Yes
No

In the event of illness/accident and/or injury, I hereby give consent for Boys to the Bush staff to perform First Aid. *

Yes
No

In the event of an emergency, I Consent to Boys to the Bush staff calling an Ambulance should they deem it necessary for the Participant. I recognise that costs involved with Ambulance travel will be my responsibility. *

Yes
No

I give consent for Boys to the Bush staff to store and administer medication/dosages as specified. *

Yes
No

I give consent for Boys to the Bush to store personal information in accordance with our Privacy Policy. *

Yes
No

To view the Privacy Policy please contact us on 0260 252 510.

Boys to the Bush may involve water activities in our programs. Can you indicate if the participant is: *

Can not swim
Average swimmer
Strong swimmer

Please list any activities the Participant can NOT take part in.

Please list any issues / behaviours / triggers etc that the camp staff should be made aware of. *

Please give us as much information as possible to help us give the participant the best experience across our programs

Please list any strategies you have to deal with these issues

Please give us as much information as possible to help us give the participant the best experience across our programs

I have read and agree to all Boys to the Bush Terms and Conditions (The link to the Terms and Conditions are found on the footer on each page). *

Yes
No

Register for one of our programs

Please email us at info@boystothebush.org.au or give us a call at 02 6025 2510 to discuss your requirements with our staff before completing this form.

Choose the program

Participant Details

Health Conditions and Medical Details

Guardian/Caseworker Contact Information

Consent and Information to Help Us