CONSENT FORM

PLEASE PRINT THIS FORM AND HAVE IT COMPLETED & SIGNED BY YOUR PARENT OR LEGAL GUARDIAN

Please then return this signed document to your School Coordinator to confirm your place.

SUMMARY OF DETAILS

First Name

Last Name

School

Confirmation Number

CONSENT - Please read carefully, initial the box and sign at the bottom to give your consent. This document MUST NOT be altered.

Initial: I confirm that I have correctly completed the online medical and registration form for my daughter/son/ward and have provided all the necessary details. If any changes occur between now and the start of the program I will notify Camp Somerset via email.

I consent to my daughter/son/ward participating in activities arranged by Camp Somerset. I acknowledge that the activities may be of an adventurous nature, often in remote bush settings. In signing this document I am aware of the general nature of these activities and that these activities represent a departure from the childs normal routines and may be physically demanding. I am aware that these activities involve an altered or increased risk of illness, injury or death arising from an accident or event occurring during an activity or within the camp environment.

I acknowledge that Camp Somerset, its instructors and staff undertake to exercise due care and skill to teach my daughter/son/ward proper outdoor techniques and to minimise exposure to known risks. I understand that all hazards and dangers associated with these activities cannot be foreseen or may be beyond the control of Camp Somerset, its instructors or staff.

I understand that the activities arranged by Camp Somerset might require the child to obey instructions and co-operate with its staff. I warrant that my daughter/son/ward has an ordinary ability to comprehend instructions given in English.

I agree that if my daughter/son/ward suffers injury or illness, Camp Somerset can, at my cost, arrange medical treatment and emergency evacuation services as Camp Somerset deems appropriate for my daughter/son/wards safety or wellbeing.

I also declare that I will read and understand the information within the PROGRAMME INFORMATION, including the EQUIPMENT LIST for my daughter/son/wards safe participation and will ensure she/he attends with all the items listed. I also understand that it is a condition of participation to accurately complete the MEDICAL AND CONSENT DETAILS.

Name of Parent or Legal Guardian Signature Date

________________________________ _________________________ ___/___/_____