Nelson Family Registration Form

Background photo: a man with a prosthetic left leg is running down the road at sunset. Front image is in a circle in the middle: a woman bent over with her hands on her knees looking worn out, with the words

Registration Form

Nelson 2023

Countdown to Camp!

Registrations will be opening soon.

Camp Fees

Adult & College age: $68pp

Intermediate & Primary age: $55pp

Preschool (0-4yrs old): Free

Fees cover all food, accommodation and activities for the whole weekend.

(Teapot Valley Christian Camp are very graciously partnering with us and thanks to their generosity and the generosity of other people and organisations we are able to offer heavily discounted camp fees. If however, this is still a barrier to your family attending, please contact us.)

EFC Nelson - Family Registration Form: 5th-7th May 2023

"*" indicates required fields

Step 1 of 34

YOUR DETAILS

Please enter all of your details first and then select 'yes' under 'do you want to register more people' for each person in your family attending camp.

First Name*

Surname*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Mobile Phone*

Home Phone

Work Phone

Email*

Enter Email Confirm Email

Do you or your family attend church*? If so, which church do you attend?

*Your answer will NOT affect your application process. Campers DO NOT have to be Christian or affiliated with a church to attend.

Date of Birth*

Please select*

Female

Male

Other

Rather not say

Do you have a disability?*

Yes

Does one of your family members attending camp have a disability?*

Yes

As NONE of your attending families members have a disability then this camp may not be for you. If you still would like to apply to come to camp, please provide a brief reason as to why you are applying:*

Please note that as spaces are limited we reserve the right to decline any applications that do not meet our eligibility criteria (see the FAQ section on the Elevate Family Camps homepage).

MEDICAL INFORMATION

To be completed for ALL attending family members.

Do you have any special food/diet requirements (e.g. gluten free, food pureed etc)?*

Yes

Please describe your special food/diet requirements below*

Do you have any allergies?*

Yes

Please list any allergies and severity*

Do you take any medication? Include self-administered and those used infrequently or only when needed (e.g. asthma or response to allergies).*

Yes

MEDICATION
Unless specifically required* and discussed with the camp director and/or the camp first aider, we do not need a copy of your/your family’s medication whilst at camp. However, it is your responsibility to ensure all medication is kept secure and away from the reach of children (even if there are no young children in your family group). The responsibility of administering any medication is solely with the adults of your family group.

*Specific requirements may include, but are not limited to, medication that must be stored in the fridge, if you carry an EpiPen, inhaler or similar with you while doing camp activities.

Please ensure that you have provided any and all allergy information, including severity, in the relevant sections for each attending family member.

Please provide details below if you have any specific requirements for your medication/s (examples above)?

FOR THOSE WITH A DISABILITY

This information assists us with assigning family supporters and accommodation. Please provide detailed information about all relevant areas.

Disability Type (select all that are applicable to you)*

Intellectual

Physical

Mental Health

Autism Syndrome

Asperger Syndrome

Medical

Other

Please describe your disability and how this affects you:*

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

Other

What activities / interests do you enjoy? (This will help us organise our camp program)

Please write any other information that the camp coordinators/helper may require to know to help support you whilst at camp e.g. behaviour, routines

Do you want to register more people?

Yes

Second Person

First Name*

Surname*

Relationship to first person

Spouse/Partner

Son/Daughter

Parent

Sibling

Other

Please specify:

Date of Birth*

Please select*

Female

Male

Other

Rather not say

MEDICAL INFORMATION

To be completed by ALL.

Do you have any special food/diet requirements (e.g. gluten free, food pureed etc)?*

Yes

Please describe your special food/diet requirements below*

Do you have any allergies?*

Yes

Please list any allergies and severity*

Do you take any medication? Include self-administered and those used infrequently or only when needed (e.g. asthma or response to allergies).*

Yes

Please provide details below if you have any specific requirements for your medication/s (examples above)?

Do you have a disability?*

Yes

FOR THOSE WITH A DISABILITY

This information assists us with assigning family supporters and accommodation. Please provide detailed information about all relevant areas.

Disability Type (select all that are applicable to you)*

Intellectual

Physical

Mental Health

Autism Syndrome

Asperger Syndrome

Medical

Other

Please describe your disability and how this affects you:*

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

Other

What activities / interests do you enjoy? (This will help us organise our camp program)

Please write any other information that the camp coordinators/helper may require to know to help support you whilst at camp e.g. behaviour, routines

Do you want to register more people?

Yes

Third Person

First Name*

Surname*

Relationship to first person

Spouse/Partner

Son/Daughter

Parent

Sibling

Other

Please specify:

Date of Birth*

Please select*

Female

Male

Other

Rather not say

MEDICAL INFORMATION

To be completed by ALL.

Do you have any special food/diet requirements (e.g. gluten free, food pureed etc)?*

Yes

Please describe your special food/diet requirements below*

Do you have any allergies?*

Yes

Please list any allergies and severity*

Do you take any medication? Include self-administered and those used infrequently or only when needed (e.g. asthma or response to allergies).*

Yes

Please provide details below if you have any specific requirements for your medication/s (examples above)?

Do you have a disability?*

Yes

FOR THOSE WITH A DISABILITY

This information assists us with assigning family supporters and accommodation. Please provide detailed information about all relevant areas.

Disability Type (select all that are applicable to you)*

Intellectual

Physical

Mental Health

Autism Syndrome

Asperger Syndrome

Medical

Other

Please describe your disability and how this affects you:*

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

Other

What activities / interests do you enjoy? (This will help us organise our camp program)

Please write any other information that the camp coordinators/helper may require to know to help support you whilst at camp e.g. behaviour, routines

Do you want to register more people?

Yes

Fourth Person

First Name*

Surname*

Relationship to first person

Spouse/Partner

Son/Daughter

Parent

Sibling

Other

Please specify:

Date of Birth*

Please select*

Female

Male

Other

Rather not say

MEDICAL INFORMATION

To be completed by ALL.

Do you have any special food/diet requirements (e.g. gluten free, food pureed etc)?*

Yes

Please describe your special food/diet requirements below*

Do you have any allergies?*

Yes

Please list any allergies and severity*

Do you take any medication? Include self-administered and those used infrequently or only when needed (e.g. asthma or response to allergies).*

Yes

Please provide details below if you have any specific requirements for your medication/s (examples above)?

Do you have a disability?*

Yes

FOR THOSE WITH A DISABILITY

This information assists us with assigning family supporters and accommodation. Please provide detailed information about all relevant areas.

Disability Type (select all that are applicable to you)*

Intellectual

Physical

Mental Health

Autism Syndrome

Asperger Syndrome

Medical

Other

Please describe your disability and how this affects you:*

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

Other

What activities / interests do you enjoy? (This will help us organise our camp program)

Please write any other information that the camp coordinators/helper may require to know to help support you whilst at camp e.g. behaviour, routines

Do you want to register more people?

Yes

Fifth Person

First Name*

Surname*

Relationship to first person

Spouse/Partner

Son/Daughter

Parent

Sibling

Other

Please specify:

Date of Birth*

Please select*

Female

Male

Other

Rather not say

MEDICAL INFORMATION

To be completed by ALL.

Do you have any special food/diet requirements (e.g. gluten free, food pureed etc)?*

Yes

Please describe your special food/diet requirements below*

Do you have any allergies?*

Yes

Please list any allergies and severity*

Do you take any medication? Include self-administered and those used infrequently or only when needed (e.g. asthma or response to allergies).*

Yes

Please provide details below if you have any specific requirements for your medication/s (examples above)?

Do you have a disability?*

Yes

FOR THOSE WITH A DISABILITY

This information assists us with assigning family supporters and accommodation. Please provide detailed information about all relevant areas.

Disability Type (select all that are applicable to you)*

Intellectual

Physical

Mental Health

Autism Syndrome

Asperger Syndrome

Medical

Other

Please describe your disability and how this affects you:*

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

Other

What activities / interests do you enjoy? (This will help us organise our camp program)

Please write any other information that the camp coordinators/helper may require to know to help support you whilst at camp e.g. behaviour, routines

Do you want to register more people?

Yes

Sixth Person

First Name*

Surname*

Relationship to first person

Spouse/Partner

Son/Daughter

Parent

Sibling

Other

Please specify:

Date of Birth*

Please select*

Female

Male

Other

Rather not say

MEDICAL INFORMATION

To be completed by ALL.

Do you have any special food/diet requirements (e.g. gluten free, food pureed etc)?*

Yes

Please describe your special food/diet requirements below*

Do you have any allergies?*

Yes

Please list any allergies and severity*

Do you take any medication? Include self-administered and those used infrequently or only when needed (e.g. asthma or response to allergies).*

Yes

Please provide details below if you have any specific requirements for your medication/s (examples above)?

Do you have a disability?*

Yes

FOR THOSE WITH A DISABILITY

This information assists us with assigning family supporters and accommodation. Please provide detailed information about all relevant areas.

Disability Type (select all that are applicable to you)*

Intellectual

Physical

Mental Health

Autism Syndrome

Asperger Syndrome

Medical

Other

Please describe your disability and how this affects you:*

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

Other

What activities / interests do you enjoy? (This will help us organise our camp program)

Please write any other information that the camp coordinators/helper may require to know to help support you whilst at camp e.g. behaviour, routines

Do you want to register more people?

Yes

Seventh Person

First Name*

Surname*

Relationship to first person

Spouse/Partner

Son/Daughter

Parent

Sibling

Other

Please specify:

Date of Birth*

Please select*

Female

Male

Other

Rather not say

MEDICAL INFORMATION

To be completed by ALL.

Do you have any special food/diet requirements (e.g. gluten free, food pureed etc)?*

Yes

Please describe your special food/diet requirements below*

Do you have any allergies?*

Yes

Please list any allergies and severity*

Do you take any medication? Include self-administered and those used infrequently or only when needed (e.g. asthma or response to allergies).*

Yes

Please provide details below if you have any specific requirements for your medication/s (examples above)?

Do you have a disability?*

Yes

FOR THOSE WITH A DISABILITY

This information assists us with assigning family supporters and accommodation. Please provide detailed information about all relevant areas.

Disability Type (select all that are applicable to you)*

Intellectual

Physical

Mental Health

Autism Syndrome

Asperger Syndrome

Medical

Other

Please describe your disability and how this affects you:*

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

Other

What activities / interests do you enjoy? (This will help us organise our camp program)

Please write any other information that the camp coordinators/helper may require to know to help support you whilst at camp e.g. behaviour, routines

Do you want to register more people?

Yes

Eighth Person

First Name*

Surname*

Relationship to first person

Spouse/Partner

Son/Daughter

Parent

Sibling

Other

Please specify:

Date of Birth*

Please select*

Female

Male

Other

Rather not say

MEDICAL INFORMATION

To be completed by ALL.

Do you have any special food/diet requirements (e.g. gluten free, food pureed etc)?*

Yes

Please describe your special food/diet requirements below*

Do you have any allergies?*

Yes

Please list any allergies and severity*

Do you take any medication? Include self-administered and those used infrequently or only when needed (e.g. asthma or response to allergies).*

Yes

Please provide details below if you have any specific requirements for your medication/s (examples above)?*

Do you have a disability?*

Yes

FOR THOSE WITH A DISABILITY

This information assists us with assigning family supporters and accommodation. Please provide detailed information about all relevant areas.

Disability Type (select all that are applicable to you)*

Intellectual

Physical

Mental Health

Autism Syndrome

Asperger Syndrome

Medical

Other

Please describe your disability and how this affects you:*

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

Other

What activities / interests do you enjoy? (This will help us organise our camp program)

Please write any other information that the camp coordinators/helper may require to know to help support you whilst at camp e.g. behaviour, routines

Do you want to register more people?

Yes

Ninth Person

First Name*

Surname*

Relationship to first person

Spouse/Partner

Son/Daughter

Parent

Sibling

Other

Please specify:

Date of Birth*

Please select*

Female

Male

Other

Rather not say

MEDICAL INFORMATION

To be completed by ALL.

Do you have any special food/diet requirements (e.g. gluten free, food pureed etc)?*

Yes

Please describe your special food/diet requirements below*

Do you have any allergies?*

Yes

Please list any allergies and severity*

Do you take any medication? Include self-administered and those used infrequently or only when needed (e.g. asthma or response to allergies).*

Yes

Please provide details below if you have any specific requirements for your medication/s (examples above)?

Do you have a disability?*

Yes

FOR THOSE WITH A DISABILITY

This information assists us with assigning family supporters and accommodation. Please provide detailed information about all relevant areas.

Disability Type (select all that are applicable to you)*

Intellectual

Physical

Mental Health

Autism Syndrome

Asperger Syndrome

Medical

Other

Please describe your disability and how this affects you:*

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

Other

What activities / interests do you enjoy? (This will help us organise our camp program)

Please write any other information that the camp coordinators/helper may require to know to help support you whilst at camp e.g. behaviour, routines

Do you want to register more people?

Yes

Tenth Person

First Name*

Surname*

Relationship to first person

Spouse/Partner

Son/Daughter

Parent

Sibling

Other

Please specify:

Date of Birth*

Please select*

Female

Male

Other

Rather not say

MEDICAL INFORMATION

To be completed by ALL.

Do you have any special food/diet requirements (e.g. gluten free, food pureed etc)?*

Yes

Please describe your special food/diet requirements below*

Do you have any allergies?*

Yes

Please list any allergies and severity*

Do you take any medication? Include self-administered and those used infrequently or only when needed (e.g. asthma or response to allergies).*

Yes

Please provide details below if you have any specific requirements for your medication/s (examples above)?

Do you have a disability?*

Yes

FOR THOSE WITH A DISABILITY

This information assists us with assigning family supporters and accommodation. Please provide detailed information about all relevant areas.

Disability Type (select all that are applicable to you)*

Intellectual

Physical

Mental Health

Autism Syndrome

Asperger Syndrome

Medical

Other

Please describe your disability and how this affects you:*

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

Other

What activities / interests do you enjoy? (This will help us organise our camp program)

Please write any other information that the camp coordinators/helper may require to know to help support you whilst at camp e.g. behaviour, routines

CAMP FEES

Camp fees include all meals for the weekend (Friday supper through to Sunday lunch), camp activities and accommodation in bunk-style rooms. Some rooms have a double bed with a single bed above, these will be prioritised to couples or campers who require a double bed due to medical or transfer needs.

Families will be allocated their own cabin room, but may need to share a bathroom with another family.

Due to the generosity of donors these camp costs are significantly subsidised, however we don’t want anybody to miss out so if there is still any problem with finance please contact us.

All fees are non-refundable (unless camp is cancelled due to covid).

Number of Adults (College age and above) Quantity

Price: $ 68.00

Quantity

Number of Children (Intermediate and Primary School age) Quantity

Price: $ 55.00

Quantity

Number of Children 0-4 years Quantity

Price: $ 0.00

Quantity

Total

Payment options:

Do not send cash through the mail.

Bank Deposit: (please include your SURNAME in the particulars and NELSON in the reference)

Acc name: Elevate Camps

Acc #:01-0142-0029706-02

Respite Care Hours: Elevate Christian Disability Trust is a registered support carer with the Ministry of Health. Please contact us if you would like to use your respite care hours for your loved one's camp fees

Fees and deposits are non-transferable. Receipts for full fees will be sent to the email address you entered above.

Payment

I will pay via internet banking

I will pay using Respite Care Hours

Please specify how much of your camp fees will be covered by Respite Care Hours:

LINEN

Teapot Valley have a very limited amount of bedding (top/bottom sheets and pillow case) that can be hired if you would rather not bring your own. Please indicate below if you would like to hire some for your family.

Please note: indicating below is NOT a guarantee that you will be able to hire linen. We will allocate the available linen on a first-in-first-served basis and will confirm with you in a separate email if your request can be met.

Please indicate how many sets of bedding you would like to request (charged at $8 per set):

How did you hear about Elevate Family Camps?*

Elevate website

Social media

Previously attended

Church

Word of mouth

Other

CONSENT

I consent to the information supplied in this form being used for the purpose of organising the camp.
I agree that ELEVATE Trust will not accept any responsibility for any loss or damage of personal property, also that leaders and or helpers cannot carry legal liability for any accident, injury or occurrence to myself (son/daughter/participant) during this camp
I agree that my name be placed on the Elevate Family Camp mailing list
I agree to abide by the ELEVATE Trust Code of Conduct and any rules as directed by the Camp Committee
If I or my family members are feeling unwell during the week leading up to camp I agree to contact the camp coordinator

I consent to the above list*

Yes

I understand that camp will be operating under the latest government guidelines in regards to Covid-19 and that precautions may include: Not coming to camp if you are feeling unwell; RAT testing if needed; Encouraging using face masks; and Social distancing*

Yes

I consent to the publication and use for promotional purposes of any Elevate Trust video and or photograph in which I or my family may appear as a result of attending this camp*

Yes

Download Camp Rules and Code of Conduct 2023

Nelson Family Registration Form

Countdown to Camp!

Camp Fees

EFC Nelson - Family Registration Form: 5th-7th May 2023

YOUR DETAILS

MEDICAL INFORMATION

FOR THOSE WITH A DISABILITY

Second Person

MEDICAL INFORMATION

FOR THOSE WITH A DISABILITY

Third Person

MEDICAL INFORMATION

FOR THOSE WITH A DISABILITY

Fourth Person

MEDICAL INFORMATION

FOR THOSE WITH A DISABILITY

Fifth Person

MEDICAL INFORMATION

FOR THOSE WITH A DISABILITY

Sixth Person

MEDICAL INFORMATION

FOR THOSE WITH A DISABILITY

Seventh Person

MEDICAL INFORMATION

FOR THOSE WITH A DISABILITY

Eighth Person

MEDICAL INFORMATION

FOR THOSE WITH A DISABILITY

Ninth Person

MEDICAL INFORMATION

FOR THOSE WITH A DISABILITY

Tenth Person

MEDICAL INFORMATION

FOR THOSE WITH A DISABILITY

CAMP FEES

Payment options:

CONSENT

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