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Child Details
CAMPERS DETAILS
How can we best describe you?
*
How can we best describe you?
Parent/Guardian (Submitting on behalf of my child)
Adult/ Staff (Accompanying students)
First One Adventures Staff
Title
Title
Dr.
Miss
Mr.
Mrs.
Prof.
Rev.
Camper's Name
*
Camper's Surname
*
School/ Organisation
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School/ Organisation
BluLever Education
Capricorn High School
Centurion Montessori School
Curro Heuwelkruin
Curro Krugersdorp High School
Deutsche Internationale Schule Johannesburg
Dunamis Christian School
Eagles Nest Christian School
First One Adventures Learnership Programme
Frans Du Toit High School
Great Grace
Johannesburg International School of American
Johannesburg Muslim School
Kingfisher Private School
Kings Court School
Lycée Jules Verne de Johannesburg
Maputo International School of American
Maragon Private School
Meridian College Phalaborwa
Meridian Cosmo City
Mitchell House
Mountain Cambridge School
Northview Christian Academy
Village Montessori School
School/ Organisation
Grade/ Phase
*
Grade/ Phase
3
4
5
6
7
8
9
10
11
12
AS 1
AS 2
FD 1
FD 2
IG 1
IG 2
Birth Day
*
Gender
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Male
Female
Email Address
*
Phone
Camp SWAG
T Shirt Size
*
Small
Medium
Large
Extra Large
2 Extra Large
DIETARY REQUIREMENTS
Dietary
*
Kosher
Halal
Normal
Vegan
Vegetarian
Other
Food Exclusion
Lactose Intolerance
No Dairy Products
No Chicken
No Fish
No Pork
No Nuts
No Red Meat
No Tin Food
Other not specified
Food you do not consume:
Please specify Diet
*
Please specify Diet
*
GUARDIAN’S
Name
*
Surname
*
Email Address
*
Cell Number
Work Number
Relationship with Camper
Mother
Father
Legal Guardian
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?
*
Is the contact person is the same person as the guardian?
Yes
No
Name
*
Surname
*
Email Address
*
Cell Number
Work Number
Relationship with Camper
Mother
Father
Legal Guardian
Spouse
PHOTOGRAPHY/ VIDEOS AT CAMP
Photographs/videos at camp
I 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.
*
Yes
No
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
*
Search
No Swimming Experience
Eliminatory
Confident
POST CAMP COMMUNICATION WITH CHILD CONSENT
Post camp interaction with campers
I 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
*
Submit