Child Details

CAMPERS DETAILS

How can we best describe you? *

Title

Camper's Name *

Camper's Surname *

School/ Organisation *School/ Organisation

Grade/ Phase *

Birth Day *

Gender *MaleFemale

Email Address *

Phone

Camp SWAG

DIETARY REQUIREMENTS

Please specify Diet *

GUARDIAN’S

Name *

Surname *

Email Address *

Cell Number

Work Number

Relationship with Camper

HEALTH QUESTIONNAIRE

What physical disabilities or conditions (heart conditions, diabetes, seizures, etc.) do you have that might affect your participation in this activity including operations illness, broken bones in the past six months? *

Any allergies, specifically bee stings, food, or medications/drugs? *

Last date of immunisation (tetanus, booster, etc.)? *

List any medications being taken? *

AUTHORISATION FOR MEDICAL TREATMENT

Please complete the following as thoroughly as possible. The information will be used only by the program leaders and any emergency medical personnel. All material is confidential.

Medical Aid Name

Medical Aid Number

Medical Aid Main Member

Main Member's ID Number

PERSON TO CONTACT IN CASE OF EMERGENCY

Is the contact person is the same person as the guardian? *

Name *

Surname *

Email Address *

Cell Number

Work Number

Relationship with Camper

PHOTOGRAPHY/ VIDEOS AT CAMP

Photographs/videos at campI give consent for photographs/videos to be taken of my child while at a First One Adventures’ camp. These are to be used solely for the purposes of record keeping and promotion of First One Adventures. All personal information collected in this form will be used for the purposes of First One Adventures and will not be disclosed to any external or third parties.

Do you give consent for First One Adventures to post photos of my child at camp on their social media, website and other media. *YesNo

WATER ACTIVITY CONSENT (SEE SAFETY @CAMP GUIDE)

Safety at Camp Guide

You can access and download our Safety@Camp Guide by clicking here

I consent my child to participate in water activities while at camp or tour with First One Adventures. (Tick below to give consent)

Swimming Pool (Under supervision)River Activities (PPE provided and supervision)Beach activities with Lifeguard [KZN & Maputo Camps]

Swimming Confidence *

POST CAMP COMMUNICATION WITH CHILD CONSENT

Post camp interaction with campersI consent my child to participate in post-camp communication with their tribe leaders from camp. All our communications between tribe leaders and campers are monitored by the camp director. We offer the following support to learners, currently through our WhatsApp channel. (Female Tribe leaders are paired with girls and Male Tribe leaders are paired with boys).

Post Camp Consent:Guidance | Career Guidance and reference to useful sources for the children’s interest. | Emotional Support guided by our experienced professionals. | A friend to listen, should the campers need someone to listen to them.

Checkbox

I consent my child to keep in contact with First One Adventures team

RELEASE OF LIABILITY AND ASSUMPTION OF RISK

Consent Statement:This form is to be read and signed on behalf of the participant attending and/or participating in a First One Adventures program or activity taking the above into consideration. In return for First One Adventures allowing the participant to participate in the First One Adventures program/activity, and other good and valuable considerations, you agree and the state as follows:

Consent Statement:This form is to be read and signed by the participant attending and/or participating in a First One Adventures program or activity taking the above into consideration. In return for First One Adventures allowing the participant to participate in the First One Adventures program/activity, and other good and valuable considerations, you agree and the state as follows:

1.I understand the inherent risks and dangers of participating in First One Adventures Program activities, initiative games, and ropes course activities, (including but not limited to the hazards of climbing or descending trees; walking on logs/wires suspended above the ground; traveling through mountainous areas; paddling or otherwise traveling through turbulent or calm waters; climbing or descending rock faces; exposure to the forces of weather and/or nature; paintballing; accidents or illnesses occurring in remote places without medical facilities and travel by air, train, motor vehicle and/or other forms of transportation which could result in property damage and personal injury; and I agree to accept all risks whether present or future, known or unknown, arising from or as a result of my child participating in these activities.

1.I understand the inherent risks and dangers of participating in First One Adventures Program activities, initiative games, and ropes course activities, (including but not limited to the hazards of climbing or descending trees; walking on logs/wires suspended above the ground; traveling through mountainous areas; paddling or otherwise traveling through turbulent or calm waters; climbing or descending rock faces; exposure to the forces of weather and/or nature; paintballing; accidents or illnesses occurring in remote places without medical facilities and travel by air, train, motor vehicle and/or other forms of transportation which could result in property damage and personal injury; and I agree to accept all risks whether present or future, known or unknown, arising from or as a result of participating in these activities.

2.I SHALL HOLD HARMLESS AND INDEMNIFY First One Adeventurres and its officials, administrators, employees, and all sponsors and individuals assisting in the presentation of the First One Adventures Program, owners of the property on which the First One Adventures Program is held for any liability and all claims of damages, demands and actions whatsoever in any manner resulting from my child participating in this program/activity.

2.I SHALL HOLD HARMLESS AND INDEMNIFY First ONE ADVENTURES and its officials, administrators, employees, and all sponsors and individuals assisting in the presentation of the First One Adventures Program, owners of the property on which the First One Adventures Program is held for any liability and all claims of damages, demands and actions whatsoever in any manner resulting from participating in this program/activity.

3.I understand my child must be healthy and reasonably fit in order to safely participate in the program.

3.I understand that I must be healthy and reasonably fit in order to safely participate in the program.

4.Beyond Program/Activity my child will inform the program/activity leader of any medication, ailment, condition, or injury that may affect their performance or reasonably preclude them from participating; and I STATE THAT I HAVE READ, UNDERSTAND, AND AGREE TO ALL CONDITIONS SET FORTH HEREIN AND THAT I SIGN VOLUNTARILY.

4.Beyond Program/Activity I will inform the program/activity leader of any medication, ailment, condition, or injury that may affect their performance or reasonably preclude them from participating; and I STATE THAT I HAVE READ, UNDERSTAND, AND AGREE TO ALL CONDITIONS SET FORTH HEREIN AND THAT I SIGN VOLUNTARILY.

5.I give consent for photographs/videos to be taken of me while at a First One Adventures camp. These are to be used solely for the purposes of record-keeping and promotion of First One Adventures. All personal information collected in this form will be used for the purposes of First One Adventures and will not be disclosed to any external or third parties.

Consent *

I have read the above and give my consent

Full Names of Parent/ Guardian: *

Full Names: *

Date *

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