National Camp – Camper Application Form National Camp - Camper Application Form 2026 Thank you for your interest in applying to attend National Camp 2026. Please complete all the fields below. "*" indicates required fields Step 1 of 34 2% 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 or group attending camp.First Name*Surname*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Mobile Phone*Home PhoneWork PhoneEmail* Enter Email Confirm Email Do you currently 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*DDDD12345678910111213141516171819202122232425262728293031MMMM123456789101112YYYYYYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please select* Female Male Other Do you have a disability?* Yes No Does one of your family members attending camp have a disability?* Yes No 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.Please select any applicable Elevate Camps and Groups you regularly attend: CFFD Joy Ministries Auckland Drop-in Centre Wellington CFFD Camp Auckland CFFD Camp Elevate Family Camp Elevate Youth Collective Transport I would like to request assistance with transport to/from camp I have my own transport to camp I can offer a ride to someone Some regions are able to assist with transport to and from camp. There is not a guarantee that transport can be provided. If you have asked for assistance with transport someone will be in contact to discuss this further. EMERGENCY CONTACTS Please provide two if you are attending camp by yourself. Name of Contact Person 1* First Last Relationship to camper*Contact's Phone Number*Contact's Alternative Phone NumberName of Contact Person 2 First Last Relationship to CamperContact's Phone NumberContact's Alternative Phone NumberDo you live in a residential or group home? Yes No Name of Residential or Group Home*Name of House Leader or Manager*Contact Phone NumberIf different from the emergency contact number provided above 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 No Please describe your special food/diet requirements below*Do you have any allergies?* Yes No Please list any allergies and severity*Do you use a CPAP or BiPAP machine? Yes No 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 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 or group 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 volunteer support and accommodation. Please provide detailed information about all relevant areas. Request for Support at Camp My family or caregiver will support me throughout camp. I do not need a volunteer assigned to me. My family or caregiver will provide overnight and personal care support but I would like to request a volunteer to support me with basic tasks during the day. I am attending camp by myself and would like to request a volunteer to support me with basic tasks during camp. Other Our camp is only able to provide volunteers to assist with basic tasks during camp. If you require assistance with transfers or personal cares you will need to bring your own support person with you. Please contact us if the additional camp fee cost for a support person is a barrier for you.Disability Type (select all that are applicable to you)* Intellectual Physical Mental Health Autism Medical Other Please describe your disability and how this affects you:*COMMUNICATION. Please select* I have good verbal communication I have limited verbal communication I use assistive technology to communicate I use NZSL to communicate Other Details about your communication aid/s, means of communication and preference for information formatMOBILITY. Please select* Independent (I walk unaided) I use crutches I use a walking frame I use a manual wheelchair I use a powered wheelchair I use a mobility scooter Other Equipment and Accommodation Requests I need access to an accessible bathroom I need a toilet close by overnight I need a private space for personal cares and changing I will bring my own hoist I would like to request the use of a hoist I will bring my own shower chair or commode I would like to request the use of a shower chair or commode I would like access to a quiet / sensory space Please select all that apply. 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 No Second PersonFirst Name*Surname*Relationship to first person Spouse/Partner Son/Daughter Parent Sibling Other Please specify:Date of Birth*DDDD12345678910111213141516171819202122232425262728293031MMMM123456789101112YYYYYYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please select* Female Male Other MEDICAL INFORMATION To be completed by ALL. Do you have any special food/diet requirements (e.g. gluten free, food pureed etc)?* Yes No Please describe your special food/diet requirements below*Do you have any allergies?* Yes No Please list any allergies and severity*Do you use a CPAP or BiPAP machine? Yes No 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 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)? Do you have a disability?* Yes No FOR THOSE WITH A DISABILITY This information assists us with assigning family supporters and accommodation. Please provide detailed information about all relevant areas. Request for Support at Camp My family or caregiver will support me throughout camp. I do not need a volunteer assigned to me. My family or caregiver will provide overnight and personal care support but I would like to request a volunteer to support me with basic tasks during the day. I am attending camp by myself and would like to request a volunteer to support me with basic tasks during camp. I won't need any assistance Other Our camp is only able to provide volunteers to assist with basic tasks during camp. If you require assistance with transfers or personal cares you will need to bring your own support person with you. Please contact us if the additional camp fee cost for a support person is a barrier for you. Disability Type (select all that are applicable to you)* Intellectual Physical Mental Health Autism Medical Other Please describe your disability and how this affects you:*COMMUNICATION. Please select* I have good verbal communication I have limited verbal communication I use assistive technology to communicate I use NZSL to communicate Other Details about your communication aid/s, means of communication, and preference for information format.MOBILITY. Please select* Independent (I walk unaided) I use crutches I use a walking frame I use a manual wheelchair I use a powered wheelchair I use a mobility scooter Other What activities / interests do you enjoy? (This will help us organise our camp program)Equipment and Accommodation Requests I need access to an accessible bathroom I need a toilet close by overnight I need a private space for personal cares and changing I will bring my own hoist I would like to request the use of a hoist I will bring my own shower chair or commode I would like to request the use of a shower chair or commode I need access to a quiet / sensory space 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 No Third PersonFirst Name*Surname*Relationship to first person Spouse/Partner Son/Daughter Parent Sibling Other Please specify:Date of Birth*DDDD12345678910111213141516171819202122232425262728293031MMMM123456789101112YYYYYYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please select* Female Male Other MEDICAL INFORMATION To be completed by ALL. Do you have any special food/diet requirements (e.g. gluten free, food pureed etc)?* Yes No Please describe your special food/diet requirements below*Do you have any allergies?* Yes No Please list any allergies and severity*Do you use a CPAP or BiPAP machine? Yes No 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 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)? Do you have a disability?* Yes No FOR THOSE WITH A DISABILITY This information assists us with assigning family supporters and accommodation. Please provide detailed information about all relevant areas. Request for Support at Camp My family or caregiver will support me throughout camp. I do not need a volunteer assigned to me. My family or caregiver will provide overnight and personal care support but I would like to request a volunteer to support me with basic tasks during the day. I am attending camp by myself and would like to request a volunteer to support me with basic tasks during camp. I won't need any assistance Other Our camp is only able to provide volunteers to assist with basic tasks during camp. If you require assistance with transfers or personal cares you will need to bring your own support person with you. Please contact us if the additional camp fee cost for a support person is a barrier for you. Disability Type (select all that are applicable to you)* Intellectual Physical Mental Health Autism Medical Other Please describe your disability and how this affects you:*COMMUNICATION. Please select* I have good verbal communication I have limited verbal communication I use assistive technology to communicate I use NZSL to communicate Details about your communication aid/s, means of communication, and preference for information formatsMOBILITY. Please select* Independent (I walk unaided) I use crutches I use a walking frame I use a manual wheelchair I use a powered wheelchair I use a mobility scooter Other Equipment and Accommodation Requests I need access to an accessible bathroom I need a toilet close by overnight I need a private space for personal cares and changing I will bring my own hoist I would like to request the use of a hoist I will bring my own shower chair or commode I would like to request the use of a shower chair or commode I need access to a quiet / sensory space 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 No Fourth PersonFirst Name*Surname*Relationship to first person Spouse/Partner Son/Daughter Parent Sibling Other Please specify:Date of Birth*DDDD12345678910111213141516171819202122232425262728293031MMMM123456789101112YYYYYYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please select* Female Male Other MEDICAL INFORMATION To be completed by ALL. Do you have any special food/diet requirements (e.g. gluten free, food pureed etc)?* Yes No Please describe your special food/diet requirements below*Do you have any allergies?* Yes No Please list any allergies and severity*Do you use a CPAP or BiPAP machine? Yes No 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 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)? Do you have a disability?* Yes No FOR THOSE WITH A DISABILITY This information assists us with assigning family supporters and accommodation. Please provide detailed information about all relevant areas. Request for Support at Camp My family or caregiver will support me throughout camp. I do not need a volunteer assigned to me. My family or caregiver will provide overnight and personal care support but I would like to request a volunteer to support me with basic tasks during the day. I am attending camp by myself and would like to request a volunteer to support me with basic tasks during camp. I won't need any assistance Other Our camp is only able to provide volunteers to assist with basic tasks during camp. If you require assistance with transfers or personal cares you will need to bring your own support person with you. Please contact us if the additional camp fee cost for a support person is a barrier for you. Disability Type (select all that are applicable to you)* Intellectual Physical Mental Health Autism Medical Other Please describe your disability and how this affects you:*COMMUNICATION. Please select* I have good verbal communication I have limited verbal communication I use assistive technology to communicate I use NZSL to communicate Details about your communication aid/s, means of communication, and preference for information formatsMOBILITY. Please select* Independent (I walk unaided) I use crutches I use a walking frame I use a manual wheelchair I use a powered wheelchair I use a mobility scooter Other Equipment and Accommodation Requests I need access to an accessible bathroom I need a toilet close by overnight I need a private space for personal cares and changing I will bring my own hoist I would like to request the use of a hoist I will bring my own shower chair or commode I would like to request the use of a shower chair or commode I need access to a quiet / sensory space 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 No Fifth PersonFirst Name*Surname*Relationship to first person Spouse/Partner Son/Daughter Parent Sibling Other Please specify:Date of Birth*DDDD12345678910111213141516171819202122232425262728293031MMMM123456789101112YYYYYYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please select* Female Male Other MEDICAL INFORMATION To be completed by ALL. Do you have any special food/diet requirements (e.g. gluten free, food pureed etc)?* Yes No Please describe your special food/diet requirements below*Do you have any allergies?* Yes No Please list any allergies and severity*Do you use a CPAP or BiPAP machine? Yes No 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 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)? Do you have a disability?* Yes No FOR THOSE WITH A DISABILITY This information assists us with assigning family supporters and accommodation. Please provide detailed information about all relevant areas. Request for Support at Camp My family or caregiver will support me throughout camp. I do not need a volunteer assigned to me. My family or caregiver will provide overnight and personal care support but I would like to request a volunteer to support me with basic tasks during the day. I am attending camp by myself and would like to request a volunteer to support me with basic tasks during camp. I won't need any assistance Other Our camp is only able to provide volunteers to assist with basic tasks during camp. If you require assistance with transfers or personal cares you will need to bring your own support person with you. Please contact us if the additional camp fee cost for a support person is a barrier for you. Disability Type (select all that are applicable to you)* Intellectual Physical Mental Health Autism Medical Other Please describe your disability and how this affects you:*COMMUNICATION. Please select* I have good verbal communication I have limited verbal communication I use assistive technology to communicate I use NSZL to communicate Details about your communication aid/s, means of communication, and preference for information formatMOBILITY. Please select* Independent (I walk unaided) I use crutches I use a walking frame I use a manual wheelchair I use a powered wheelchair I use a mobility scooter Other Equipment and Accommodation Requests I need access to an accessible bathroom I need a toilet close by overnight I need a private space for personal cares and changing I will bring my own hoist I would like to request the use of a hoist I will bring my own shower chair or commode I would like to request the use of a shower chair or commode I need access to a quiet / sensory space 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 No Sixth PersonFirst Name*Surname*Relationship to first person Spouse/Partner Son/Daughter Parent Sibling Other Please specify:Date of Birth*DDDD12345678910111213141516171819202122232425262728293031MMMM123456789101112YYYYYYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please select* Female Male Other MEDICAL INFORMATION To be completed by ALL. Do you have any special food/diet requirements (e.g. gluten free, food pureed etc)?* Yes No Please describe your special food/diet requirements below*Do you have any allergies?* Yes No Please list any allergies and severity*Do you use a CPAP or BiPAP machine? Yes No 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 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)? Do you have a disability?* Yes No FOR THOSE WITH A DISABILITY This information assists us with assigning family supporters and accommodation. Please provide detailed information about all relevant areas. Request for Support at Camp My family or caregiver will support me throughout camp. I do not need a volunteer assigned to me. My family or caregiver will provide overnight and personal care support but I would like to request a volunteer to support me with basic tasks during the day. I am attending camp by myself and would like to request a volunteer to support me with basic tasks during camp. I won't need any assistance Other Our camp is only able to provide volunteers to assist with basic tasks during camp. If you require assistance with transfers or personal cares you will need to bring your own support person with you. Please contact us if the additional camp fee cost for a support person is a barrier for you. Disability Type (select all that are applicable to you)* Intellectual Physical Mental Health Autism Medical Other Please describe your disability and how this affects you:*COMMUNICATION. Please select* I have good verbal communication I have limited verbal communication I use assistive technology to communicate I use NZSL to communicate Details about your communication aid/s, means of communication, and preference for information formatMOBILITY. Please select* Independent (I walk unaided) I use crutches I use a walking frame I use a manual wheelchair I use a powered wheelchair I use a mobility scooter Other Equipment and Accommodation Requests I need access to an accessible bathroom I need a toilet close by overnight I need a private space for personal cares and changing I will bring my own hoist I would like to request the use of a hoist I will bring my own shower chair or commode I would like to request the use of a shower chair or commode I need access to a quiet / sensory space 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 No Seventh PersonFirst Name*Surname*Relationship to first person Spouse/Partner Son/Daughter Parent Sibling Other Please specify:Date of Birth*DDDD12345678910111213141516171819202122232425262728293031MMMM123456789101112YYYYYYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please select* Female Male Other MEDICAL INFORMATION To be completed by ALL. Do you have any special food/diet requirements (e.g. gluten free, food pureed etc)?* Yes No Please describe your special food/diet requirements below*Do you have any allergies?* Yes No Please list any allergies and severity*Do you use a CPAP or BiPAP machine? Yes No 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 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)? Do you have a disability?* Yes No FOR THOSE WITH A DISABILITY This information assists us with assigning family supporters and accommodation. Please provide detailed information about all relevant areas. Request for Support at Camp My family or caregiver will support me throughout camp. I do not need a volunteer assigned to me. My family or caregiver will provide overnight and personal care support but I would like to request a volunteer to support me with basic tasks during the day. I am attending camp by myself and would like to request a volunteer to support me with basic tasks during camp. I won't need any assistance Other Our camp is only able to provide volunteers to assist with basic tasks during camp. If you require assistance with transfers or personal cares you will need to bring your own support person with you. Please contact us if the additional camp fee cost for a support person is a barrier for you. Disability Type (select all that are applicable to you)* Intellectual Physical Mental Health Autism Medical Other Please describe your disability and how this affects you:*COMMUNICATION. Please select* I have good verbal communication I have limited verbal communication I use assistive technology to communicate I use NZSL to communicate Details about your communication aid/s, means of communication, and preference for information formatMOBILITY. Please select* Independent (I walk unaided) I use crutches I use a walking frame I use a manual wheelchair I use a powered wheelchair I use a mobility scooter Other Equipment and Accommodation Requests I need access to an accessible bathroom I need a toilet close by overnight I need a private space for personal cares and changing I will bring my own hoist I would like to request the use of a hoist I will bring my own shower chair or commode I would like to request the use of a shower chair or commode I need access to a quiet / sensory space 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 No Eighth PersonFirst Name*Surname*Relationship to first person Spouse/Partner Son/Daughter Parent Sibling Other Please specify:Date of Birth*DDDD12345678910111213141516171819202122232425262728293031MMMM123456789101112YYYYYYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please select* Female Male Other MEDICAL INFORMATION To be completed by ALL. Do you have any special food/diet requirements (e.g. gluten free, food pureed etc)?* Yes No Please describe your special food/diet requirements below*Do you have any allergies?* Yes No Please list any allergies and severity*Do you use a CPAP or BiPAP machine? Yes No 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 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)?* Do you have a disability?* Yes No FOR THOSE WITH A DISABILITY This information assists us with assigning family supporters and accommodation. Please provide detailed information about all relevant areas. Request for Support at Camp My family or caregiver will support me throughout camp. I do not need a volunteer assigned to me. My family or caregiver will provide overnight and personal care support but I would like to request a volunteer to support me with basic tasks during the day. I am attending camp by myself and would like to request a volunteer to support me with basic tasks during camp. I won't need any assistance Other Our camp is only able to provide volunteers to assist with basic tasks during camp. If you require assistance with transfers or personal cares you will need to bring your own support person with you. Please contact us if the additional camp fee cost for a support person is a barrier for you. Disability Type (select all that are applicable to you)* Intellectual Physical Mental Health Autism Medical Other Please describe your disability and how this affects you:*COMMUNICATION. Please select* I have good verbal communication I have limited verbal communication I use assistive technology to communicate I use NZSL to communicate Details about your communication aid/s, means of communication, and preference for information formatMOBILITY. Please select* Independent (I walk unaided) I use crutches I use a walking frame I use a manual wheelchair I use a powered wheelchair I use a mobility scooter Other Equipment and Accommodation Requests I need access to an accessible bathroom I need a toilet close by overnight I need a private space for personal cares and changing I will bring my own hoist I would like to request the use of a hoist I will bring my own shower chair or commode I would like to request the use of a shower chair or commode I need access to a quiet / sensory space 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 No Ninth PersonFirst Name*Surname*Relationship to first person Spouse/Partner Son/Daughter Parent Sibling Other Please specify:Date of Birth*DDDD12345678910111213141516171819202122232425262728293031MMMM123456789101112YYYYYYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please select* Female Male Other MEDICAL INFORMATION To be completed by ALL. Do you have any special food/diet requirements (e.g. gluten free, food pureed etc)?* Yes No Please describe your special food/diet requirements below*Do you have any allergies?* Yes No Please list any allergies and severity*Do you use a CPAP or BiPAP machine? Yes No 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 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)? Do you have a disability?* Yes No FOR THOSE WITH A DISABILITY This information assists us with assigning family supporters and accommodation. Please provide detailed information about all relevant areas. Request for Support at Camp My family or caregiver will support me throughout camp. I do not need a volunteer assigned to me. My family or caregiver will provide overnight and personal care support but I would like to request a volunteer to support me with basic tasks during the day. I am attending camp by myself and would like to request a volunteer to support me with basic tasks during camp. I won't need any assistance Other Our camp is only able to provide volunteers to assist with basic tasks during camp. If you require assistance with transfers or personal cares you will need to bring your own support person with you. Please contact us if the additional camp fee cost for a support person is a barrier for you. Disability Type (select all that are applicable to you)* Intellectual Physical Mental Health Autism Medical Other Please describe your disability and how this affects you:*COMMUNICATION. Please select* I have good verbal communication I have limited verbal communication I use assistive technology to communicate I use NZSL to communicate Details about your communication aid/s and/or means of communicationMOBILITY. Please select* Independent (I walk unaided) I use crutches I use a walking frame I use a manual wheelchair I use a powered wheelchair I use a mobility scooter Other Equipment and Accommodation Requests I need access to an accessible bathroom I need a toilet close by overnight I need a private space for personal cares and changing I will bring my own hoist I would like to request the use of a hoist I will bring my own shower chair or commode I would like to request the use of a shower chair or commode I need access to a quiet / sensory space 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 No Tenth PersonFirst Name*Surname*Relationship to first person Spouse/Partner Son/Daughter Parent Sibling Other Please specify:Date of Birth*DDDD12345678910111213141516171819202122232425262728293031MMMM123456789101112YYYYYYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please select* Female Male Other MEDICAL INFORMATION To be completed by ALL. Do you have any special food/diet requirements (e.g. gluten free, food pureed etc)?* Yes No Please describe your special food/diet requirements below*Do you have any allergies?* Yes No Please list any allergies and severity*Do you use a CPAP or BiPAP machine? Yes No 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 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)? Do you have a disability?* Yes No FOR THOSE WITH A DISABILITY This information assists us with assigning family supporters and accommodation. Please provide detailed information about all relevant areas. Request for Support at Camp My family or caregiver will support me throughout camp. I do not need a volunteer assigned to me. My family or caregiver will provide overnight and personal care support but I would like to request a volunteer to support me with basic tasks during the day. I am attending camp by myself and would like to request a volunteer to support me with basic tasks during camp. I won't need any assistance Other Our camp is only able to provide volunteers to assist with basic tasks during camp. If you require assistance with transfers or personal cares you will need to bring your own support person with you. Please contact us if the additional camp fee cost for a support person is a barrier for you. Disability Type (select all that are applicable to you)* Intellectual Physical Mental Health Autism Medical Other Please describe your disability and how this affects you:*COMMUNICATION. Please select* I have good verbal communication I have limited verbal communication I use assistive technology to communicate I use NZSL to communicate Other Details about your communication aid/s, means of communication and preference for information formatMOBILITY. Please select* Independent (I walk unaided) I use crutches I use a walking frame I use a manual wheelchair I use a powered wheelchair I use a mobility scooter Other Equipment and Accommodation Requests I need access to an accessible bathroom I need a toilet close by overnight I need a private space for personal cares and changing I will bring my own hoist I would like to request the use of a hoist I will bring my own shower chair or commode I would like to request the use of a shower chair or commode I need access to a quiet / sensory space 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 (not a full dinner) through to Monday lunch), camp activities, and accommodation. Accommodation is allocated based primarily on access needs. There is limited family/group accommodation options. We understand that camp fees may be a barrier for some people. We don’t want anybody to miss out so if there is difficulty with finance please contact us as we may be able to assist with sponsorship. Please contact our staff at hello@elevate.org.nz if camp fees are not affordable for you. All fees are non-refundable.Number of adults and young people aged 15+ years Quantity Price: $295.00 Quantity Number of children aged 10-14 years Quantity Price: $195.00 Quantity Number of children aged 4-9 years Quantity Price: $120.00 Quantity Number of infants aged 0-3 years Quantity Price: $0.00 Quantity Total Payment options: Do not send cash through the mail. You will be invoiced for your camp fees via email. It may take a number of days for us to invoice you. 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 or a family members camp fees. If you are using Respite Care or Individualised Funding this amount will be deducted from your invoice.Payment I will pay via internet banking I will pay using Respite Care Hours or Individualised Funding Please specify how much of your camp fees will be covered by Respite Care Hours: 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 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 No Δ
