Application Form 09

Maryborough Madness Application Form Bookings cannot be made over the phone. Please send this application form to the address over the page. Name:____________________________________  Address:__________________________________  ________________________P/C_______________

Camp Directors: Geoff Parnell Ph: 0412 338 122 122 Sharon Klein Ph: 0427 771 207 E-mail: E-mail:[email protected]

Mon 21st - Fri 25th September 2009

Ph:____________________ Mobile:______________________ D.O.B:______/_____/______ School:____________________________________ Grade:______

Male/Female (Please Circle)

Parent/Guardian Name _____________________ Father Mother Guardian

Payment Details:  Full Camp fee $115 (Please Tick) CHEQUE

 Deposit $30

It’s It’s on o n Again! A gain! Agai n!

Canoeing Waterslide Mini Olympics Abseiling Games and More!!!

h  h  g g    u u    o o    r r    o o    b b    y y    r r    a  a   M  9 09     0 0  s 2 0  s   s  e  s  n d   e  ad    n  M a 

MONEY ORDER

(Please Include the name of the camp on the back of the cheque)

OR

CREDIT CARD : I authorize SU Qld to deduct my:

Visa MasterCard Amount $_________ Card Number _____________________________ Name on Card ____________________________ Expiry Date ____/____ Signature _________________________________

Please make Cheques or Money Orders payable to:

Scripture Union Queensland

All activities, food and transport included in camp fee and all all only only $115 $115 !! 5 Fun Filled Days for Grades 5 & 6

Don’t Miss Out !!!

Maryborough Madness

Child Protection Statement of Commitment:

Five days of fun, excitement and great adventures guaranteed.  Abseiling,  Abseiling, canoeing, canoeing, bushcraft,  watersliding,  watersliding, beach activities, great spiritual programme and more.

 Aldershot Scout Camp-September Camp-September 21st-25th 2009

Apply early to avoid disappointment!!

SU Qld holiday camps are conducted by Scripture Union, a world-wide interdenominational organization. Our camps are staffed by voluntary leaders with a mix of experienced and new leaders, all trained in youth camping. Each camp consists of a balanced program aimed at meeting physical, social, mental and spiritual needs. Leaders also pay camp fees.

 A camper letter will will be sent to you on receipt of your your application. It will include more details about the program, a medical form, what to bring and what not to bring.  ALL forms must be completed completed and returned before camp.

SU Qld is committed to the safety and holistic  w e l l - b e i n g o f a l l c h i l d r e n a n d y o u n g p e o p l e involved in our events. To ensure that children and young people are kept safe from harm, our staff and volunteers are required to possess a current Blue Card, agree to adhere to a code of conduct and undergo training in child safety. SU Qld takes child protection and safety seriously and consequently has policies and procedures in place to ensure that your child has the best experiences with us.

Parent/ Camper Agreement: I understand that the camp leaders will take all reasonable care of my child whilst at camp, but that SU Qld and its representatives  w i l l n o t b e l i a b l e f o r a n y i n j u r y o r a c c i d e n t , or for loss or damage to property. I give my consent for and agree to pay f or any necessary medical treatment. I understand that in case of unacceptable behaviour campers will be sent home from camp. Parent/Guardian Name:  __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ 

SU Qld may withhold a late cancellation fee. SU Qld reserves the right to reject applications.

Signature:  __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _

Please cut off this section and return to:

Information about our Privacy Policy is available at www.suqld.org.au

Maryborough Madness c/-C.O.C P.O Box 461, Maryborough 4650