Participant Application - D'Sozo Camp WA

Thank you for your interest in attending D'Sozo Camp WA.

Please take a few moments to familiarise yourself with the Camp Handbook before proceeding.

I have read the handbook *

Please Upload or Take a Recent Photo of Yourself *

Firstname *

Date of Birth *

Address *

City *

State *

Postcode *

Lastname *

Gender *

Email Address *

Phone / Mobile *

Parent's Contact Details

Name of Father *

Father's Mobile *

Father's Work Phone

Name of Mother *

Mother's Mobile *

Mother's Work Phone

Alternative / Emergency Contact

Name *

Mobile Phone *

Relation to You *

Home Phone

Work Phone

General Info

Main Reasons for Applying *

What school do you currently attend? *

Musical Experience

Enter any instruments you play, including how long you've been playing them and your level of proficiency (e.g. beginner, intermediate or advanced)

What musical part(s) can you sing? *

Medical

Tick any medical history that applies to you. All answers will be held in strict confidence.

Other medical history / notes

Allergies

Please provide details of allergies

Do you have private health insurance?

Health Insurance Details

Financial

Please note: D'Sozo camp is the result of God leading in the many lives of those who have been willing to give of their time and talents to it happen. No-one receives personal financial gain from camp fees.

Fees include one week of accomodation and meals (breakfast, lunch and light tea).

Pickup and Dropoff is available from Perth airport.

Camp Fee *

Pickup / Dropoff

Optional Donation $ (expenses may be higher than actual fees charged)

Please choose the payment method that applies

Please send bank deposits to Eastward Public Relations account:

Account Name:	Eastward Public Relations
Bank:	Commonwealth
BSB:	06 2623
Account Number:	1016 1600

Cheques may be posted to:
Eastward Missionary College
665 Upper Rollands Plains Rd
Rollands Plains, NSW 2441

Authorisation

If you are under 18 years of age, your parent/legal guardian must fill in the following:

As a parent and/or legal guardian of the above applicant I am in favor of he/she attending D'Sozo Camp and participating in all activities, including those off campus, unless otherwise specified in writing. I hereby release Eastward Missionary College from liability in case of accident or illness, and understand I am responsible for any charges incurred in treatment of my child's illness/ accident. In case of emergency, I understand every effort will be made to contact me. In the event I cannot be reached, I hereby give permission to the medical personnel at the D'Sozo Camp to administer first aid as deemed appropriate and/or if necessary to hospitalise, and in which case for the hospital staff, to administer anesthesia and medications or perform surgery as required, on the above applicant.

Eastward may use pictures of the above applicant taken during camp for promotional and/or illustrative purposes

Parent/legal guardian's name

Relationship to applicant

Phone number (mobile prefered)

Participant Agreement

I have carefully read the Participant Handbook and as the applicant, I agree to abide by all the camp codes and guidelines, and to cooperate fully with Eastward staff. I understand that if I fail to do so, I may be sent home at my expense and forfeit all camp fees. *

By clicking the submit button below you agree that the information you have entered in this application form is true and correct to the best of your knowledge. You will not be able to edit the application after submitting it.

Submit Application