Maryborough Madness Application Form

Bookings cannot be made over the phone. Please post this application to the address over the page. Name:____________________________________ Address:__________________________________ ________________________P/C_______________ Ph:____________________ Mobile:______________________ D.O.B:______/_____/______ School:____________________________________ Grade:______ Male/Female (Please Circle)

Camp Director: Andrew Storrs Ph: 0417 787 982 Admin/Alternate Contact: Sharon Klein Ph: 07 41222300 E-mail:maryboroughmadness@suqld.org Postal: c/- 22 Cheyne Cct, Tinana Q 4650

Its on Again!
Mon 24th - Fri 30th September 2011

Parent/Guardian Name _____________________ Full Camp fee $150* (Please Tick) CHEQUE
OR

aryborough M dness 2011 Ma

Deposit $50 MONEY ORDER

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

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:

5 Fun Filled Days Grades 5 & 6

Scripture Union Queensland

*subject to change

Dont Miss Out !!!

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

Child Protection Statement of Commitment:

SU Qld is committed to the safety and holistic well-being of all children and young people 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.

Aldershot Scout Camp-September 24th-30th 2011

Parent/ Camper Agreement:

I understand that the camp leaders will take a l l r e a s o n a bl e c a r e o f m y c h i l d w h i l s t a t camp, but that SU Qld and its representatives will not be liable for any injury or accident, or for loss or damage to property. I give my consent for and agree to pay for any necessary medical treatment. I u n d e r s t a n d t h a t i n c a s e o f u n a c c e p t a bl e behaviour campers will be sent home from camp. Parent/Guardian Name:
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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 by the due date.

Signature:

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

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

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