AUCKLAND CFFD CAMP FORM 2021

Please complete in full, even if you have attended/completed this form in previous years.

Please print your details and complete as fully as possible. We require everyone to complete the form, both helpers and those with disabilities. This information is vital for the smooth running of the camp.

First Name/s(Required)

Surname or Family Name(Required)

Please Select(Required)

Male

Female

Do you have a disability?

Yes

Your Age (Please Select)(Required)

Please select(Required)

I am a camper

I am a volunteer helper

I am a caregiver attending with a camper

Name of camper(Required)

If you have a disability, please tick the option that applies to you:

I will bring my own caregiver

I require an assigned volunteer helper

I require some assistance but don’t need an assigned helper

I don’t need an assistant

Address

Street Address(Required)

Suburb, City or Town(Required)

Post Code

Email(Required)

Enter Email Confirm Email

Phone Numbers

Home Phone Number(Required)

Work Phone Number

MobileNumber

Note contact person must not be at camp and MUST be able to be contacted 24 hours a day.

Name Of Emergency Contact person:(Required)

First Last

Emergency Contact’s Phone No. (home)(Required)

Emergency Contact’s Phone No. (Mobile)

Emergency Contact Person's Relationship to Camper(Required)

Parent

Caregiver

Group Home Manager

Other

Transport

Do you need transport?

Yes

If you are a car owners are you willing to provide transport for camp?

Yes

Type of vehicle

Car

Van

Number of Seats available (apart from the driver and other campers on this form)

Can you take a manual wheelchair?

Yes

Please Select: I am coming to(Required)

the Full Camp

as a Day Vistior

Full price- Child (5-12)

Price:

Price for a Caregiver/Helper

Price:

Camper (over 12 years)

Price:

Day Visitors Saturday Lunch Only

Price: $18.00

Day Visitor Sunday Lunch

Price: $18.00

Day Visitor Saturday Dinner Only

Price: $25.00

Day Visitor Saturday Lunch and Dinner

Price: $43.00

I am paying

A deposit (minimum $30)

The Full Fee

Visitors Fee

Total

My fee is being paid by :

Cheque

Online via Internet

Respite care hours

Please make cheques payable to “C.F.F.D. -Auckland”

If paying via internet banking, our account is C.F.F.D.-Auckland Branch. ANZ bank, Account Number: 01 0142 0029685 02 Please include your name and CFFD Camp

Personal Information

Have you been to a CFFD, Joy, or Elevate CDT camp before?(Required)

Yes

What is your height ?(Required)

Short

Medium

Tall

What is Your Weight (please select)(Required)

Under 56 kg

56kg to 75kg

75kg to 95kg

Over 95kg

Can you sleep in a top bunk

Yes

Do you require a plug for Bipap/Cpap machine

Yes

Do you have allergies or special dietary requirements?

Yes

Please list your allergies and/ or special dietary requirements:

List medical conditions (not disability) and devices eg diabetes, pacemaker, bipap machine etc

Do you take medication?(Required)

Yes

MEDICATION (Please send us a separate list if necessary printed from your pharmacist or caregiver, group home etc. including self administered). This is a legal requirement, due to Health and Safety regulations. Please state even if self-administered.

Medication Name	How often taken	Dosage	Times taken
eg. Aldactone	eg. 2 per day	eg 25 mg	eg. 8 am, 8 pm

List your medication below(Required)

Disability Section

Please provide detailed information. This assists us with assigning buddies and accommodation. If there is a care plan please send this to us.

Disability(Required)

Physical

Intellectual

Autism

Other

Describe Your Disability if necessary

Communication(Required)

Details about your communication aid/s

Mobility(Required)

Independent

Crutches

Walking Frame

Manual Wheelchair

Electric Wheelchair

Transfers(Required)

Independent

1 person assistance

2 person assistance

Hoist

Toileting(Required)

Independent

prompting/minimal assist

full assistance

Commode (bring own)

Nappies/Night pads

supra Pubic Catheter

Indwelling Catheter

Self-catheterising

Shower(Required)

Independent

minimal assist

1 person assistance

2 person assistance

Dressing(Required)

Independant

Minimal assistance

1 person assistance

2 person assistance

Eating(Required)

Independant

Minimal Assistance

Full assistance

Choking risk or special diet requirements

Notes about your routines or other information that might be useful(Required)

Comments

Please send us more details by email about your disability or needs if necessary

Helpers: Please let us know if you cannot help with lifting or have needs of your own for us to be aware of.

There is a time for training and touching base with our buddies and learning more about their specific care needs on the Friday night camp begins. No person is expected to have all the answers and there is always a lot of care prayer and thought put in place when matching buddies. We have an excellent team of support folk at camp who will help and guide you if you need it. Especially for first time buddies.

All: If you play an instrument and would be prepared to play it at camp, please feel free to bring it. We will have a line dance at camp on the Saturday night so all campers prepare yourselves for some fun, bling, glam and shazam in the name of worship fun.

Everyone: Terms and Conditions- Please Read and Sign:

I consent to the information supplied in this form being used by the camp committee for the purpose of organising the affairs of the camp.
I consent to any publication of any Elevate CDT or CFFD video and or photograph in which I may appear as a result of attending 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.
I agree that Elevate CDT/ CFFD Auckland will not accept responsibility for any loss or damage to 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 understand that the Camp Directors have the right to decline any registration.
I also agree to abide by any rules as directed by the Camp Directors.
All first-time helpers are required to complete the attached Police Check form and return it with this registration form.

Note: this form must be signed. If it is not signed your registration will be declined.

I consent to the above list(Required)

Yes

Christian Fellowship For Disabled Auckland Camp 2021

AUCKLAND CFFD CAMP FORM 2021

Address

Phone Numbers

Transport

Please make cheques payable to “C.F.F.D. -Auckland”

Personal Information

Disability Section

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