Personal Details

Name

First Name

Last Name

Preferred Name

Mobile Number

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Medical Info:

Non-food Allergies

Please give any information regarding allergies other than food allergies

Medical Conditions

Medication

Please give any details about any medications you need to regularly take

Special diets/food allergies

Please give a short summary of any special dietary requirements you have. You will also need to fill out a dietary form for the campsite: https://www.fccjuniorcamp.com/dietary-requirements

Medicare Number

Position on Medicare Card

Emergency Contact

Emergency Contact Name 1

First Name

Last Name

Relationship to You

Primary Contact Number

Secondary Contact Number

Emergency Contact Name 2

First Name

Last Name

Relationship to You

Primary Contact

Secondary Contact Number

Child Protection Details

WWCC Number

You MUST have a valid WWCC Number to serve on camp

WWCC Expiry Date

Birth Date

Your DOB is required to check your WWCC

Training

Have you done a child protection course recently?

Training Details

Please give any details about when/where your training was. Please email (fccjuniorcamp@gmail.com) any certificates or other paperwork.

Church

Which Church do you regularly attend?

Minister Name

Please give a Minister’s name for a reference

First Name

Last Name

Minister Contact Number

Other Stuff

Availability

If you are not able to lead all week, what days are you available?

Monday

Tuesday

Wednesday

Thursday

Friday

Unsure

Whatever day you need me most

Year Group

Please give us an indication about which year group you would prefer leading? (No guarantees)

Any

3/4

4/5

5/6

6/7

Experience

Experience is not a requirement but is helpful to know for us when organising leader groups etc. Please provide some brief information about any experience you have had leading youth and children.

First Aid Certificate

Do you have a valid first aid certificate? (not required)

Skills

Please give an indication of any skills you have or roles you would like to be considered for.

Anything Else?

Is there anything else that you feel we should know?

Disclaimer

I understand that while every possible action will be taken to ensure your safety, and while all due care will be exercised by the other leaders, directors, Camp Fletcher staff, they will not incur any liability for any accident or sickness to you or any damage to personal property that might occur. Should you require urgent hospital or medical treatment, I hereby give my consent for the leaders/directors to obtain the necessary treatment with all possible speed and for it to be at my own expense. I understand that in the event of such an emergency occurring, that wherever possible, every reasonable effort will be made to contact your emergency contacts before treatment is undertaken. For more information about our illness and injury policy, you can find it here: https://www.fccjuniorcamp.com/illness-injury As part of camp, you will be photographed for camp mementos, promotional purposes of future camps, and for use in the promotion of FCC run events.

Thank you for offering to help us lead FCC Junior Camp this year! We will be in contact with you soon

Leader Registration