Your Full Name (required)

Your Contact number (required)

Your Email (required)

Your Address(required)

Number of Family Members Attending Family Camp (required)

Preferred Accommodation
DormCamping

ALL INFORMATION IS CONFIDENTIAL and will be deleted once the retreat has finished. This information is helpful for the facilitator leading the retreat and for the retreat managers in planning the meals and accommodation

Please fill in details below of each participant.

Participant 1 (person filling in the registration form)

Gender

Name

Age

Food allergies or special dietary needs
Please list any food allergies or special dietary needs that we should be aware of.

Physical disabilities
Please list any physical disabilities we need to be aware of (for purposes of getting around, eating, sleeping).

Medical Concerns
Please list any serious medical conditions or mental illnesses (such as depression, panic attacks, schizophrenia) that it would be helpful for us to know about

Medication
If you are currently taking any kind of medication that we should be made aware of, please enter details.

Participant 2

Gender

Name

Age

Relationship to you

Food allergies or special dietary needs
Please list any food allergies or special dietary needs that we should be aware of.

Physical disabilities
Please list any physical disabilities we need to be aware of (for purposes of getting around, eating, sleeping)

Medical Concerns
Please list any serious medical conditions or mental illnesses (such as depression, panic attacks, schizophrenia) that it would be helpful for us to know about

Medication
If you are currently taking any kind of medication that we should be made aware of, please enter details

Participant 3

Gender

Name

Age

Relationship to you

Food allergies or special dietary needs
Please list any food allergies or special dietary needs that we should be aware of.

Physical disabilities
Please list any physical disabilities we need to be aware of (for purposes of getting around, eating, sleeping).

Medical Concerns
Please list any serious medical conditions or mental illnesses (such as depression, panic attacks, schizophrenia) that it would be helpful for us to know about

Medication
If you are currently taking any kind of medication that we should be made aware of, please enter details.

Participant 4

Gender

Name

Age

Relationship to you

Food allergies or special dietary needs
Please list any food allergies or special dietary needs that we should be aware of.

Physical disabilities
Please list any physical disabilities we need to be aware of (for purposes of getting around, eating, sleeping).

Medical Concerns
Please list any serious medical conditions or mental illnesses (such as depression, panic attacks, schizophrenia) that it would be helpful for us to know about

Medication
If you are currently taking any kind of medication that we should be made aware of, please enter details.

Participant 5

Gender

Name

Age

Relationship to you

Food allergies or special dietary needs
Please list any food allergies or special dietary needs that we should be aware of.

Physical disabilities
Please list any physical disabilities we need to be aware of (for purposes of getting around, eating, sleeping).

Medical Concerns
Please list any serious medical conditions or mental illnesses (such as depression, panic attacks, schizophrenia) that it would be helpful for us to know about

Medication
If you are currently taking any kind of medication that we should be made aware of, please enter details.

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Emergency Contact Info

Emergency Contact name

Contact number of Emergency Contact Name

Relationship to you

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