Day Camp Registration

Child 1*

First Name Last Name

Birth Date*

Day Month Year

Gender*

Male Female

PLEASE SELECT DAYS ($70 a day / $300 a week)*

Mon 4th Tue 5th Wed 6th Thu 7th - Waitlist Fri 8th Full Week

I require a camp shirt for my child

Yes ($10)

Would you like to add another child?

YES NO

Child 2

First Name Last Name

Birth Date

Day Month Year

Gender

Male Female

PLEASE SELECT DAYS ($63 a day / $270 a week)

Mon 4th Tue 5th Wed 6th Thu 7th - Waitlist Fri 8th Full Week

I require a camp shirt for my child

Yes ($10)

Would you like to add another child?

YES NO

Child 3

First Name Last Name

Birth Date

Day Month Year

Gender

Male Female

PLEASE SELECT DAYS ($63 a day / $270 a week)

Mon 4th Tue 5th Wed 6th Thu 7th - Waitlist Fri 8th Full Week

I require a camp shirt for my child

Yes ($10)

Would you like to add another child?

YES NO

Child 4

First Name Last Name

Birth Date

Day Month Year

Gender

Male Female

PLEASE SELECT DAYS ($63 a day / $270 a week)

Mon 4th Tue 5th Wed 6th Thu 7th - Waitlist Fri 8th Full Week

I require a camp shirt for my child

Yes ($10)

Parent/ Guardian 1*

First Name Last Name

Mobile Number*

E-mail* Primary email

Address*

Street Address
Street Address Line 2
City	State
Postcode	Country

Parent / Guardian 2

First Name Last Name

Mobile Phone

E-mail

How did you hear about us?

Emergency Contact*

First Name Last Name

Phone Number*

Relationship*

It is a safety requirement that all children wear DHS camp tshirts on all excursions. There is a $10 fee for the shirt. (Shirt can be used for future DHS camps).

If you have our orange camp shirt from previous years, you may wear it, otherwise you will need to purchase one.

Please add in the comments below what sizes you require.

I acknowledge that I have read and agree to the Conditions of Enrolment (found below).

I am signing up my child for camp. I give my child permission to attend all trips and receive medical care in the case of emergency, G-d forbid. I give Dover Heights Shule permission to photograph and videotape my children and use the photos and videos (without their names) for whatever the camp sees fit.

CLICK HERE FOR CONDITIONS OF ENROLMENT

CLICK HERE TO VIEW OUR PRIVACY POLICY

Agreement*

I agree to the above Conditions of Enrolment.

Please note: The 10% discount is only for additional SIBLINGS. If multible children, who are not siblings, are booked on the same form, the amount calculated below will be manually adjusted accordingly.

TOTAL

$0.00 AUD

Payment*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

General comments

1. Child/ren’s Information

2. Parent information

3. Emergency Information

4. Payment Information