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Register for one of our programs
Program Application Form
Choose the program
Program Type
*
Holiday Camp
MENtoring Program
Individualised Program
Other
Case Worker / Guardian Details
Case Worker / Guardian Name
*
First
Last
Case Worker / Guardian Phone Number
*
Case Worker / Guardian Email
*
About the Participant
Participant Name
*
First
Last
Date of Birth
*
Address
*
City
*
State
*
NSW
QLD
VIC
ACT
TAS
NT
Postcode
*
School Grade
*
Participant Medicare Number
*
Does the Participant identify as Aboriginal or Torres Strait Islander?
*
Yes
No
Parent / Carer Name
*
First
Last
Address (if different from above)
Mobile Number
*
Emergency Contact Name
*
First
Last
Relationship to Participant
*
Contact Number
*
Consent and information to help us
Please list any Allergies or Special Dietary Requirements
Please list any Medical Conditions along with details of medications/dosage requirements
I consent to Boys To The Bush Inc. taking photos and/or video footage of my son/ward whilst on the camp.
*
Yes
No
I consent to Boys To The Bush Inc. 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 Inc. staff to perform First Aid.
*
Yes
No
In the event of an emergency, I Consent to Boys To The Bush Ltd. staff calling an Ambulance should they deem it necessary for my son/ward. I recognise that costs involved with Ambulance travel will be my responsibility.
*
Yes
No
I give consent for Boys To The Bush Inc. staff to store and administer medication/dosages as specified.
*
Yes
No
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 list any strategies you have to deal with these issues
I have read and agree to all Camp Terms and Conditions (Terms and Conditions are found at www.boystothebush.org.au/camp-info/).
*
Yes
No
Phone
Submit
