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 Sharon Klein Ph: 0427 771 207 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: (Please Tick) CHEQUE

It’s on Again!

Full Camp fee $115 Deposit $30

Canoeing Waterslide Mini Olympics Abseiling Games and More!!!

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

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 only $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, canoeing, bushcraft, watersliding, beach activities, great spiritual programme and more.

Aldershot Scout 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 be sent to you on receipt of 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 and returned before camp.

S U Q l d i s c om mi t t e d t o t h e sa f et y a n d ho l i s t i c w e l l - b e i n g of a l l c hi l dre n a nd y o u ng p eo pl e i nv o l v ed i n ou r e v e nt s . T o en s u r e t ha t c h i l d re n a nd y o un g p eop l e a r e k ept sa f e f r o m ha r m, o u r st a f f a nd v ol u nt ee r s a r e r e q u i re d t o p o s se s s a cu r r e nt B l u e Ca r d, a g r ee t o a dh e r e t o a cod e o f co n du ct a nd u n d e rg o t r a i ni n g i n c hi l d sa f et y. S U Ql d t a k e s c hi l d p r ot ec t i on a n d sa f et y se r i o u s l y a n d co n s eq u en t l y h a s po l i c i e s a n d p r o ce d u re s i n pl a c e t o e n s u r e t ha t y ou r c h i l d h a s t h e b e st e x p er i en ce s w i t h u s .

Parent/ Camper Agreement: I u n de r st a n d t h a t t h e ca m p l ea de r s wi l l t a k e a l l re a s on a bl e ca r e of m y c h i l d wh i l s t a t c a mp , b ut t ha t S U Ql d a n d i t s re p re s e nt a t i v e s w i l l n ot b e l i a b l e f o r a ny i n j u r y o r a c ci de nt , o r f o r l o s s or d a m a g e t o pr o pe rt y . I g i v e m y c o n se nt f o r a n d a g r e e t o pa y f o r a n y n ec e s sa r y m ed i c a l t r ea t m en t . I u n de r st a n d t h a t i n ca se of u n a c c ept a bl e b e h a v i o u r c a m pe r s w i l l b e s e nt h om e f ro m c a mp . P a r en t / G ua r di a n N a m e: ___________________________________________________________________________________________

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

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

S i g n a t u re : ___________________________________________________________________________________________

Please cut off this section and return to: Maryborough Madness c/-C.O.C P.O Box 461, Maryborough 4650