Famsy Beach Camp Reg Form 2008

In the name of Allah, the Compassionate, the Merciful ADDRESS

FAMSY (VICTORIA)

POSTAL

PO Box 451, Newport VIC 3015 GENERAL ENQUIRIES

Rifat 0431526748 0422 851 108 BROTHERS CAMP END OF YEAR 2008– REGISTRATIONBasil FORM

Ahmed 0447276063

PARTICIPANT NAME

E-MAIL

___________________________________ [email protected] [email protected]

ADDRESS

WEBSITE ___________________________________

www.famsy.com

HALAQAH GROUP (if applicable) ___________________________ will be attending YOUTH CAMP – END OF YEAR 2008, organised by FAMSY VICTORIA.

ANGLESEA

from 10.00 am 28/11/2006 to 7.00 pm 30/11/2006 cost $AUD 119 (covers transport, activities)

venue, accomodation, food &

Health / fitness aspects that may need special attention, including allergies ______________________________________________ Other Participant Details: PARTICIPANT MOBILE PHONE NUMBER______________________________ PARTICIPANT EMAIL ADDRESS _____________________________________ PARTICIPANT MEDICARE NUMBER __________________________________ IF NEW TO FAMSY: WOULD YOU BE INTERESTED IN ATTENDING AN ISLAMIC STUDY CIRLE? Y / N (circle) IN CASE OF EMERGENCY, CONTACT (name)___________________________ TELEPHONE NUMBER:______________________________________________ I authorise any volunteer or member of FAMSY Inc, Victoria Chapter, in the event of any accident or illness to obtain such urgent medical assistance or treatment for the above named youth member, including the administration of any anaesthetic or blood transfusion as he or she may consider expedient and for this purpose to engage any first aides, ambulance officers, doctors, dentists, nursing assistance or hospital accommodation and in this event I agree to pay the said Association on demand all such doctors', dentists’, nurses', ambulance and hospital fees (other than fees and expenses recoverable by the said Association under any policy of insurance). I also agree not to hold FAMSY or any of their volunteers liable for accidents or injury that may arise during the camp.

SIGNED____________________________ PRINT NAME________________________DATE__________________________

Note: Please deposit the camp attendance fee at Commonwealth bank

BSB: 063 112 ACCOUNT#: 10258470 Federation of Australian Muslim students and youth Please put your Name as Reference for the deposit.