CYM Camp Melbourne Registration

Who are you registering for Camp?*
- Myself
- Myself and Others
- Myself and My Family (min. 2 adults + 2 children)
Attendees*
Please insert attendees details.
To add others from your family, click the + icon on the right.
First Name Last Name Gender Date of Birth (dd/mm/yyyy)
Attendees*
Please insert your first and last name.
To add others from your family, click the + icon on the right.
First Name Last Name Gender Date of Birth (dd/mm/yyyy)
Contact Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Home Phone
Mobile Phone
Email*
Enter Email Confirm Email

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In Case of Emergency Contact*
First Last
Relationship to Attendee*
Relationship to Attendees*
Relationship to Family*
Emergency Contact Address
Same as previous

Street Address City State / Province / Region ZIP / Postal Code Country
Emergency Contact - Home Phone
Emergency Contact - Mobile Phone*
Emergency Contact - Email*

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Working With Children
CYM Melbourne Guidelines
In 2012, all Australian states and territories with responsibility for a Working with Children Check program adopted a consistent approach towards people doing child-related work across borders.
The national policy has been implemented in conjunction with the laws and programs of each state and territory.
In the interest of safety for our youth, CYM Melbourne has made the decision that ALL PERSONS AGED 18 OR ABOVE attending camp overnight must have a valid Working with Children's Check or equivalent qualification from their country, state, or territory presented upon registration.

For details of the Check in each state and territory, please refer to the relevant websites listed below:
• Victoria: www.workingwithchildren.vic.gov.au
• South Australia: www.screening.dcsi.sa.gov.au
• Queensland: www.bluecard.qld.gov.au
• Nothern Territory: www.nt.gov.au/emergency/community-safety/apply-for-a-working-with-childrenclearance
• ACT: www.accesscanberra.act.gov.au/app/answers/detail/a_id/1804/~/ working-with-vulnerable-people-%28wwvp%29-registration
• Tasmania: www.justice.tas.gov.au/working_with_children
• New South Wales: www.kidsguardian.nsw.gov.au/child-safe-organisations/working-with-childrencheck
Working With Children's Check
Note: All persons aged 18 or above attending camp overnight must have a valid Working With Children's Check or equivalent qualification presented upon registration.
Click the '+' symbol to add more individual's details.
Individual's Name WWC State WWC Number WWC Expiry (dd/mm/yyyy)

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First Aid Qualifications
These qualifications must be current.
- Level 2 Certificate (includes Asthma, CPR, Epipen)
- Ambulance Officer/Paramedic
- Nurse
- Doctor
- Other
First Aid Qualification Details*
Please include your certification details below.
To add another individual's qualifications, or add more qualifications, click the '+' icon to add another row.
Individual's Name Type of Certification Year of Certification Year of Expiry (mm/yyyy)
Ambulance Officer / Paramedic*
Please enter your details below.
Click the '+' icon to add more information.
Individual's Name Specialty
Nurse*
Please enter your details below.
Click the '+' icon to add more information.
Individual's Name Specialty
Doctor*
Please enter your details below.
Click the '+' icon to add more information.
Individual's Name Specialty
Other First Aid Qualification*
Please provide your other First Aid qualifications details below.
Other First Aid Notes

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Medicare Details*
Please provide your Medicare details below.
If registering more than one person, click on the '+' icon to add extra details.
Individual's Name Medicare Card Number Reference Number Expiry Date (mm/yyyy)
Medical/Hospital Insurance Fund
Please enter your Medical/Hospital Insurance Fund Details Below.
Click on the '+' icon to add details for other individuals if required.
Individual's Name Fund Name Fund Membership Number
Family Medical/Hospital Insurance Fund
Family Medical/Hospital Insurance Fund Details
Individual's Name Membership Number
Doctor/GP Contact Details
Family Doctor/GP Contact Details

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Attendee Medical History

Please click on 'Add Attendee' to complete the Medical History Details.

Attendee Name	Medical History	Allergies	Tetanus Immunisation	Tablets and Medications	Dietary Requirements
						Edit Delete
There are no Attendees.

Maximum number of attendees reached.

Consent to Medical Attention*
I authorise the leaders in charge of the camp activities / excursions / events, for me and all those listed above to receive such medical or surgical treatment as may be deemed necessary, if we are incapacitated to give our consent and where it is impracticable to communicate with our Emergency Contact. I declare the information provided on this form is complete and correct. I understand that it is our responsibility to notify the Camp Administration of any changes to these details.
- I Agree to the above.

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Declaration*
Camp Payments:
I agree to pay all fees and charges for this camp by the due date, or as otherwise agreed to in writing by the Camp Organising Committee.
- I agree to pay all fees and charges
Data Collection:*
The information collected is for the purpose of planning and organising activities for camp participants. It will be disclosed as appropriate to those conducting activities. This information will be kept securely and disposed of after the event. It is your responsibility to notify Camp Administration or the CYM Melbourne of any changes in details.
- I approve my information be kept for these purposes
Acceptable behaviour:*
I acknowledge that acceptable standards of behaviour will be expected of all camp participants and attendees.

I understand that acceptable standards of behaviour and expectations of participants are outlined in CYM policies and set by senior camp leaders.

I understand that in the event of serious misconduct or misbehaviour during camp, or during camp activities, the individual(s) may be returned home or excluded from further participating. I further understand that in such circumstances, I will be informed and any costs associated with the return will be my responsibility and no claim will be made for any compensation or damages.
- I understand and am accountable for my behaviour
Authorisation for Medical Attention:*
In the event that the camp administration cannot contact us, authorised persons or legal guardians, we authorise the Administration to pursue medical attention for any of the participants I have registered in accordance with the recommendation of a qualified practitioner.
- I authorise the use of medical attention
Authorisation for Excursions:*
I am aware that the camp program may include trips, hikes, overnight stays and sporting activities, both on-site and off-site, and can involve physical activities which inherently carry risk of injury. Understanding this I give permission for my children to participate in all the camp activities.

Where I am unable to be contacted or it is otherwise impracticable for me to be contacted, I authorise the leaders in charge of any excursion or activity of participants (as identified in the Camp Participant Details section):
• to seek medical or surgical assistance as is recommended by a medical practitioner in the event of any illness or accident
• to seek first aid considered to be reasonably necessary in the event of any illness or accident

I accept all risks involved in the administration of medical, surgical or first aid treatment considered necessary and the responsibility for payment of all expenses incurred in relation to such treatment and any emergency transportation required.

I also accept that my child may be excluded from the camp or activity in the event of serious misbehaviour and that any cost associated with this will be met by me.
I give consent for my child to travel by private car or bus for the purpose of attending camp activities outside the camp grounds.
- I accept all as outlined above
Use of Image Permission:*
I give permission for photographs / images of the person / persons named previously, to be used without acknowledgement, remuneration or compensation, in various promotional materials authorised by the Ukrainian Youth Association, including but not limited to, programs, newsletters, posters, websites, social media, magazines, and newspaper articles.
- I give permission
CYM Policies:*
I have read and agree to abide by the following policies and associated procedures:
• CYM Melbourne Code of Conduct
• CYM Melbourne Child Protection Policy
- I abide by these policies and procedures
Declaration*
Please Fill in Your name and Date. This will be taken as a virtual signature to the overall completion of declaration of this form as a legal document.

All parties over the age of 18 must fill out this section.
First Name Last Name Date (dd/mm/yyyy)
Name
This field is for validation purposes and should be left unchanged.

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CYM Camp Melbourne Registration

Melbourne Camp Registration Form 2019-2020

Step 1 of 8

Working With Children

Attendance Type - Certain Days

Attendance Type - Entire Camp

Attendee Allergy Details

Attendee Tetanus Information

Attendee Medications

Attendee Dietary Requirements

Attendee Previous Experience

Attendee Assistance

Individual's Name	Type of Certification	Year of Certification	Year of Expiry (mm/yyyy)

Individual's Name	Medicare Card Number	Reference Number	Expiry Date (mm/yyyy)

Name	Dosage Amount (e.g 1 tablet)	Dosage Times (e.g breakfast, lunch, dinner)

First Name	Last Name	Gender	Date of Birth (dd/mm/yyyy)

First Name	Last Name	Gender	Date of Birth (dd/mm/yyyy)

Individual's Name	WWC State	WWC Number	WWC Expiry (dd/mm/yyyy)

First Name	Last Name	Date (dd/mm/yyyy)