Name of Camper *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Information *

Name of Emergency Contact

First Name

Last Name

Today's Date *

MM

DD

YYYY

Parental Consent *

By typing your name below, you confirm that: - I have read the above information and I give permission for the person named above to attend and take part in any planned activities. I also give my consent to any medical treatment that may be necessary in the event of an emergency. Please note that only those with parental responsibility can sign this consent (N.B. This may not include a foster carer). - In an emergency and / or if I am not contactable, I consent to my child receiving doctor, hospital or dental treatment, including the use of anaesthetic. - I agree to the above details being held by Arura Trust N.I. in accordance with their data policy.

First Name

Last Name

Date *

MM

DD

YYYY