Camp Form - Online Other Forms of Payment
  General Enquiries: (03)97379475     Bookings: 0418 170 027
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Camp Application Form for Other Forms of Payment
  1. Which camp are you applying for?(*)
    Please select which camp you are applying for
  2. Select Number of Children in this Application
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  3. Camp Fee - Full Fee or Deposit?(*)

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  4. I will pay the balance of Payment at camp(*)
    Please confirm you will be paying the remainder of your camp fees at camp.
  5. Child Details
  6. First Name:(*)
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  7. Surname:(*)
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  8. Date of Birth(*)
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  9. Gender:(*)
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  10. Grade at School:(*)
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  11. School Attended
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  12. Dietary Requirements:(*)
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  13. Dietary Details:
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  14. Bed Wetting?:
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  15. Medicare Number(*)
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  16. Permission for First Aid to be given at camp as required:(*)
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  17. Permission for Panadol to be given at camp as required:(*)
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  18. Permission for Medical Treatment to be given at camp as required:(*)
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  19. History

    If there is some particular area where you would love to see confidence or self-esteem increased in your child, it would help us to know, so that we can work on that during the camp. Please let us know if your child needs special understanding. All information will be kept private and confidential.

  20. Areas to Work on
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  21. Child 2 Details
  22. First Name:(*)
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  23. Surname:(*)
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  24. Date of Birth(*)
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  25. Gender:(*)
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  26. Grade at School:(*)
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  27. School Attended
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  28. Dietary Requirements:(*)
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  29. Dietary Details:
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  30. Bed Wetting?:
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  31. Medicare Number(*)
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  32. Permission for First Aid to be given at camp as required:(*)
    Invalid Input
  33. Permission for Panadol to be given at camp as required:(*)
    Invalid Input
  34. Permission for Medical Treatment to be given at camp as required:(*)
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  35. History

    If there is some particular area where you would love to see confidence or self-esteem increased in your child, it would help us to know, so that we can work on that during the camp. Please let us know if your child needs special understanding. All information will be kept private and confidential.

  36. Areas to Work on
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  37. Special Skills, Abilities or Interests:
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  38. Child 3 Details
  39. First Name:(*)
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  40. Surname:(*)
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  41. Date of Birth(*)
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  42. Gender:(*)
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  43. Grade at School:(*)
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  44. School Attended
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  45. Dietary Requirements:(*)
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  46. Dietary Details:
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  47. Bed Wetting?:
    Invalid Input
  48. Medicare Number(*)
    Invalid Input
  49. Permission for First Aid to be given at camp as required:(*)
    Invalid Input
  50. Permission for Panadol to be given at camp as required:(*)
    Invalid Input
  51. History

    If there is some particular area where you would love to see confidence or self-esteem increased in your child, it would help us to know, so that we can work on that during the camp. Please let us know if your child needs special understanding. All information will be kept private and confidential.

  52. Special Skills, Abilities or Interests:
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  53. Areas to Work on
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  54. Parent / Guardian Details
  55. First Name:(*)
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  56. Surname:(*)
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  57. Address:(*)
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  58. Postcode:(*)
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  59. Emergency Phone Number(*)
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  60. Alternate Emergency Phone Number(*)
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  61. Permission for Medical Treatment to be given at camp as required:(*)
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  62. Email:(*)
    Please specify your email address.
  63. I understand that by allowing the above children to attend “Kids of Gold” Camp, that all staff and volunteers cannot be held liable for any accidents or injuries that may occur during the duration of the camp.
  64. Sign Here (Type Name):(*)
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  65. Special Skills, Abilities or Interests:
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  66. Current Total
  67. Select Method of Payment(*)
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  68. Total
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Kids of Gold

A.B.N 57 327 231 835
Registered Incorporated Association No. A0050015Z
 
Registered Address:
323 Monbulk Road
Silvan Victoria 3795