AUCKLAND CFFD CAMP FORM 2023

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 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 / Work Phone Number(Required)

If you do not have a landline, please enter a Mobile Number here.

Mobile Number

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 or Mobile)(Required)

Emergency Contact’s Phone No. (Alternative Number)

Emergency Contact Person's Relationship to Camper(Required)

Parent

Caregiver

Group Home Manager

Other

Please specify your relationship to Camper(Required)

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:

Camper (over 12 years)

Price:

Day Visitors Saturday Lunch Only

Price: $25.00

Day Visitor Saturday Dinner Only

Price: $32.00

Day Visitor Saturday Lunch and Dinner

Price: $50.00

Day Visitor Sunday Lunch

Price: $25.00

I am paying

A deposit (minimum $40)

The Full Fee

Visitors Fee

Total

My fee is being paid by :

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:(Required)

For example: need soft food only, or thickened drinks, gluten-free, dairy-free diabetic etc If necessary, please list this information on a separate page.

Upload a page for detailed allergies and or special dietary requirements if required

Max. file size: 50 MB.

MEDICATION

Medications: Do you take medication?

Yes

Please provide a list with this registration form of ALL your medications including self administered.(Required)

Attach a separate list if necessary printed from your pharmacist or caregiver, or group home. This is a legal requirement, due to Health and Safety regulations.
Please include the Medication Name, How often taken, Dosage and Times taken.

Upload a separate file listing for your medications here

Max. file size: 50 MB.

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

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 helpers are required to complete the a Police Check form and return it. Please send completed forms with id to policevetting@elevate.org.nz. You will receive more detailed instructions by email after submitting this 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

If you are not filling this out online. Please print this form and complete it. Click the button below to download the form.

Please return the form in person to ELEVATE Christian Disability Trust 173 Mt Smart Rd, Onehunga, Auckland.

Or via post to

Jean Griffiths
1/68A Mount Smart Road,
Onehunga
Auckland 1061

Please remember to allow additional time for the post (3 – 5 days).

2023 Auckland CFFD Camp Form

Christian Fellowship For Disabled Auckland Camp 2023 Forms

AUCKLAND CFFD CAMP FORM 2023

Address

Phone Numbers

Transport

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

Personal Information

Disability Section

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