Register - Boys to the bush

Choose the program

Program Type *

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 *

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 *

Email *

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 the Participant 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 the Participant. 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 (The link to the Terms and Conditions are found on the footer on each page). *

Yes
No

Register for one of our programs

Choose the program

Case Worker / Guardian Details

About the Participant

Consent and information to help us