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You are here: Home / Elevate National Camp Registration Form 2023

Elevate National Camp Registration Form 2023

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All campers and helpers, irrespective of age, MUST complete one form per person

BASIC INFORMATION
First Name*
Last Name*
Date of Birth*
How old will you be on the 20th October?*
Please enter a number from 0 to 99.
Please select*
- Female
- Male
Are you coming as a volunteer helper?*
- Yes
- No
Are you attending camp with someone to be their caregiver?*
- Yes
- No
What is the name of the person you are caregiving for?*
Do you have a disability?*
- Yes
- No
Please select the option applicable to you:*
- I will be bringing my own caregiver
- I require an assigned volunteer helper
- I require some assistance but don't need an assigned helper
- I won't need any assistance
Street Address*
Suburb
City or Town*
Post Code
Do you live in the Auckland Region?
- Yes
- No
Preferred Phone Number*
Alternative Phone Number*
Email*
Email Confirm Email
Contact Person
Please note that the contact person that you list below must not be at camp and MUST be able to be contacted at any time of the day. If all your immediate family is coming to camp, your emergency contact person could be a family friend or relative.
Name of contact person (not at camp):*
First Last
Contact’s phone number*
Contact’s alternative phone number
Do you live in a group home, residential care, or rest home?*
- Yes
- No
Elevate Ministry Group you attend (tick if applicable)
- CFFD
- Joy Ministries
- Drop in Centre
- Torch
- Emmanuel Support
Please tick which of our camps (if any) you have attended
- National Camp
- CFFD Area/Regional Camp
- Joy Ministries National Camp
- Torch Camp
- Emmanuel Support (parent retreats and family camp)
Name of the Church you regularly attend
If you have musical experience, would you like to be considered for the worship team at camp?
- Yes
- No
Please describe what experience you have (including singing) and list instruments played

RESIDENTIAL GROUP HOME
Name of Group Home
Name of House Leader or Manager
Contact person prior to camp (and their position)
Phone number

HELPERS
Is this your first time as a helper at National Camp?*
- Yes
- No
Have you attended National Camp in the last 2 years?*
- Yes
- No
If you are a first-time helper or have not been a helper at National Camp in the last two years, we require you to consent to a police vetting.

(Please note that the committee reserve the right to request a police vetting of any helpers regardless of when the last police vetting was completed).

Please print and fill in the form: Elevate - Police Vetting Form (opens in a new window or use right click and save as)

Send it to us as soon as possible, along with a copy of your ID to:
- Post: ELEVATE CAMPS, PO Box 13322, Onehunga 1632 Auckland
- Email: nationalcamp@elevatecdt.org.nz
How will you send the Police Check Consent Form to us?
- I will email it
- I will post it
Are you able to lift?*
- Yes
- No
Do you have experience with hoist transfers?
- Yes
- No
Are you a medical professional, caregiver, or have had previous experience working with people who have a disability (including NZSL interpreter)?
- Yes
- No
Please state your profession, qualifications and experience (e.g. OT, Nurse, Kids Ministry, Caregiving, Hoist Transfers, Sound Desk Experience, etc.)
(e.g. OT, Nurse, Kids Ministry, Caregiver, Hoist Transfers, Sound Desk experience, etc)

AUCKLAND TRANSPORT
Do you need transport?
- Yes
- No
Are you a car owner who is willing to provide transport for Camp
- Yes
- No
Type of vehicle
- Car
- Van
- Station Wagon
- Other
Number of Seats available (apart from the driver and other campers you are already taking)
Can you take a manual wheelchair?
- Yes
- No

MEDICAL INFORMATION
To be completed by ALL.
What is your height*
- Short
- Medium
- Tall
What is Your Weight*
- Under 56 kg
- 56 kg to 76 kg
- 76 kg to 95 kg
- Over 95 kg
Can you sleep in a top bunk*
- Yes
- No
Do you snore?*
- Yes
- No
Do you use a CPAP or BiPAP machine?*
- Yes
- No
Do you have insulin injections?*
- Yes
- No
Do you have any special food requirements (e.g. gluten free, allergies, diabetic, pureed or soft food only)?*
- Yes
- No
Please describe your special food requirements below*
Do you have any allergies to medication, food, bees, etc?*
- Yes
- No
Please list your allergies below (food, medications, bees, other)*
Medical Conditions
Please list any medical conditions you have other than your disability (e.g. Diabetes, Epilepsy, etc.) Disability is included in the next section.
Do you take any medication? Include self-administered and those used infrequently or only when needed (e.g. asthma or response to allergies).*
- Yes
- No
MEDICATION
Please state even if self-administered:

Medication Name How often taken Times taken Dosage

e.g. Aldactone e.g. 2x per day e.g. 8 am, 8 pm e.g. 25 mg
List your medication below ( including self administered)*

FOR THOSE WITH A DISABILITY
This information assists us with assigning buddies and accommodation. Please provide detailed information about all relevant areas.
Disability Type (select all that are applicable to you)*
- Physical
- Intellectual
- Autism/Asperger Syndrome
- Mental Health
- Other
Describe your primary disability and any other conditions. Please include mental health conditions.*
COMMUNICATION | SPEECH. Please select*
- Good
- Fair
- Poor
Details about your communication aid/s and/or means of communication
MOBILITY. Please select*
- Independent ( I walk unaided)
- I use crutches
- I use a walking frame
- I use a manual wheelchair
- I use an electric wheelchair
TRANSFERS, e.g. getting into bed*
- Independent
- One person assistance
- Two person assistance
- Hoist transfer
Please bring a hoist if necessary.
TOILET. Please select*
- Independent
- One person assistance
- Full assistance
Please bring your own commode, if you require it.
I use ...
SHOWER. Please select*
- Independent
- Minimal assistance
- Full assistance
Please bring a shower chair if necessary.
DRESSING*
- Independent
- Minimal assistance
- Full assistance
EATING*
- Independent
- Minimal assistance
- Full assistance
Do you have difficulty swallowing or have a high risk of choking?*
- Yes
- No
For example, you might only be able to eat pureed food, soft food, small pieces or may eat normal food but require supervision. If yes, please provide details in the additional information section following this question.

ADDITIONAL INFORMATION
The information you provide helps us with assigning buddies and to know how we can assist you during camp.

If there is information that would be helpful for the camp organisers to know please include this here, for example, personal circumstances, previous health issues including mental health issues, how you cope with stress, etc.

If you have a disability please include any information that the person assisting you might need to know, that is not already included in the previous section, for example, your routines, behaviour, and other assistance required. If you have difficulty communicating please include information such as interests and preferences.

Please send us more details by email about your disability or needs, if neccessary. Send to nationalcamp@elevatecdt.org.nz
Please include any additional information or comments here.

CAMP FEES
Please select*
- Adult
- Child 11-14 years
- Child 5-10 years
- Child 0- 4 years
Total
$ 0.00
PAYMENT OPTIONS
Bank Transfer/Deposit: 01-0142-0029706-05 (please use last name and first name of the camper as the reference).
Carer Support Hours: please contact the office for details
Credit Card Payment: there is an additional 3% surcharge for any payments made using this method
You will be sent an email with this information after your registration is processed. (Fees and Deposits are non-transferable and non-refundable. Excepts at the discretion of the Camp Committee.)
Payment
- I will pay by internet banking
- I will pay using carer support hours
- I will pay by credit card

CONSENT
- I consent to the information supplied in this form being used by the Elevate Staff and Camp Leadership Team for the purpose of organising the affairs of the camp. As per the Privacy Act 2020, all information will be stored securely.
- I agree that my name be placed on the National Camp email list. You can unsubscribe from this at any time.
- I agree to abide by the code of conduct and camp rules. Click here to read the National Camp Rules and Code of Conduct 2023
- I agree to abide by any rules as directed by the Camp Director and Camp Leadership Team.
- I agree that Elevate Christian Disability Trust will not accept any responsibility for loss or damage of personal property.
- I agree that leaders and/or volunteers cannot carry legal liability for any accident, injury or occurrence to myself/family member/camp attendee during this camp.
- In an emergency, all effort will be made to contact the emergency contact noted on this form. If this person cannot be reached, then the Camp Directors will take action, as seen appropriate in the circumstances, and will not be held liable.
- I consent to the publication of any video and/or photograph in which I may appear as a result of attending this camp.
- I understand that the Camp Directors have the right to decline any registration.
I consent to the above list*
- Yes

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