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Camper Application Form
Applications for camp must be submitted at least three weeks before a camp session commences.
Early booking is essential!
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Relationship to Camper
*
Select
I am a legal guardian/custodial parent
I am NOT a legal guardian/custodial parent
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*
I agree to the Terms of Use and Privacy Policy.
Begin Application
Name
*
First
Last
Nickname
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Name camper goes by
Gender
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Male
Female
Other
Please specify.
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Date of Birth
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Proof of ID
*
ID Document
Passport
Abridged Birth Certificate
File Upload
*
Click or drag a file to this area to upload.
Upload a copy in PDF, PNG or JPEG.
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Name of School/Youth Center
*
Location of School/Youth Center
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Grade
*
Select Grade
6th
7th
8th
9th
10th
11th
12th
Camper Cell No.
*
Camper Email
How did you hear about us?
*
Select
Recommended
Camper
Parent
Friend
School
Social Media
Google Search
Other online media or website
Print magazine or newspaper
Print Ad
Radio
Camp Genesis presentation at school
Third Party Review
Other
Please specify.
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Film Boot Camp
11 to 21 December 2025 - Enrolment Fee: R7,495.00 / Deposit: R300.00 (included)
Teen Leadership Camp
27 March to 4 April 2026 - Enrolment Fee: R5,995.00 / Deposit: R300.00 (included)
Genesis Bootcamp
29 June to 12 July 2026 - Enrolment Fee: R9,495.00 / Deposit: R300.00 (included)
Select Your Camp
*
Film Boot Camp
Teen Leadership Camp
Genesis Bootcamp
Camp T-Shirt/ Sweater
*
Select Size
11-12
13-14
Small
Medium
Large
XL
XXL
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Title
*
Select
Mr
Mrs
Miss
Ms
Prof
Dr
Rev
Pastor
Sister
Father
Name
*
First
Last
Occupation
*
Marital Status
*
Select
Married
Divorced
Separated
Single
Widowed
Relationship to Camper
*
Select
Mother
Father
Stepmother
Stepfather
Legal Guardian
Grandmother
Grandfather
Sibling
Aunt
Uncle
Other
Please specify.
*
What is your relationship to child?
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Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Email Address
*
Other Email
Cellphone Number
*
Alternative Contact Number
*
Eg. Office or home
Emergency Contact
In the event you or another parent/guardian cannot be reached, please provide two alternate contacts.
Contact Person 1
*
Name + Surname / Relationship
Phone Number
*
Eg. Office, home or cell
Contact Person 2
*
Name + Surname / Relationship
Phone Number
*
Eg. Office, home or cell
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Allergies, disabilities or medical conditions
*
Please specify
Dietary Needs
*
Select
No special requirements
Vegetarian
Gluten-free
Nut-free
Halaal
Vegan
Does your child need to take medication to camp?
*
Yes
No
Please specify.
*
List medications the applicant is currently taking.
Is your child covered by medical aid?
*
Yes
No
Medical Aid Card
Click or drag files to this area to upload.
You can upload up to 2 files.
Copy of medical aid card for private hospital cover (front & back of card).
ID of the main or principal member
Click or drag files to this area to upload.
You can upload up to 2 files.
ID or Driver's License will be accepted.
Policy Name
*
Policy Number
*
Name of Principal Member
*
First
Last
Medical aid dependent code
Agreement for Medical Expenses
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I have entrusted my child into the care of Camp Genesis.
Checkboxes 2
*
I hereby give permission to seek emergency medical treatment for my child where necessary.
Checkboxes 3
*
I agree that, I am responsible for all medical bills incurred for the treatment of my child; and
Checkboxes 4
*
If I can't be reached, I authorize Camp Genesis to take my child to a government medical facility.
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Acknowledgements
My child is insured by a medical aid, a copy of which I am sending with this form, failing which I agree that my child can be treated at the nearest government hospital in a situation which the Camp considers a medical emergency. I am responsible for all medical bills incurred for the treatment of my child while visiting Camp Genesis. I give permission to Camp Genesis to secure necessary medical treatment for my child, which may include (but is not limited to) hospitalization, surgery, ordering of injections, anesthesia and other medical care, including exchanging medical information with a third party care giver. Camp Genesis has been given full disclosure of any pre-existing physical or mental ailments from which my child suffer.
Signature of first parent/guardian
*
Clear Signature
Use a mouse or a touch screen to sign.
Signature of second parent/guardian
Clear Signature
Use a mouse or a touch screen to sign.
Important
If only one signature is provided, consent is implied from the other parent/guardian. The signing party indemnifies Camp Genesis and its directors from all claims brought by a non-signing parent/guardian for any act or omission affecting the participant and shall defend all such matters and pay any compromise or judgment resulting there-from.
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Terms & Conditions
(including acknowledgment and assumption of risks and agreements of release and indemnity) Please read this document carefully. It informs you of certain activities of Camp Genesis and their risks, and affects your legal rights in the event of an injury or other loss. It must be signed by the Camper and by his/her parent(s) or guardian (referred to below as "Parent"). Camper signs to acknowledge certain understandings and Parent agrees to all provisions, for himself or herself and on behalf of the Camper. This Agreement will continue in full force and effect for subsequent years and Camp terms for which Camper registers, until and unless modified by written agreement. In consideration of the opportunity to participate in the Camp Genesis experience, Camper acknowledges, and Parent acknowledges and agrees, as follows: Activities and Risks Camper and Parent understand that Camp Genesis offers a variety of activities, including vigorous sports and games, water activities, exercise, fitness, and other activities, including crafts and creative projects. A list of the activities offered has been made available to us, and Camp activities are described, including photos, in the Camp Genesis Brochure, which we have received and reviewed, either online or in print. We understand that all campers are expected to participate in all activities unless the Camp is advised in writing by a Parent that a medical condition prevents participation. Risks of Camp activities are inherent in the Camp Genesis experience; that is, they cannot be eliminated without significantly altering the nature of the activities and reducing their value and appeal. These risks include those associated with motor vehicle travel, including by van and bus; exposure to the elements of nature, including heat, cold, rain, wind, lightning and fire; falls and abrupt and forceful contact with man-made and natural structures; close personal contact and physical trauma associated with sports and other recreation; falls, bites and other risks associated with errors of judgment, failure to follow instructions, and careless conduct of other campers, staff and other persons with whom the Camp may contract for certain services; and other risks ordinarily associated with camp activities and vigorous recreation in a rugged outdoor environment. Campers may suffer cuts, fractures and sprains, insect bites, plant and other allergies, food and water related ailments, trauma from contact with other persons and objects, heat and cold from exposure to the natural elements, emotional upset and, in extraordinary cases, death, including by drowning. Other risks may be encountered, of course. We understand that the areas of the camp to which campers have access include a dam and river frontage, rocky, uneven and rugged wooded terrain, potentially harmful plants, and other creatures which sting or bite, all common to the Kogelberg and Hottentots Holland Biospheres. Camp activities may include travel off the premises to nearby towns and recreation opportunities in vehicles that may be furnished and/or driven by persons with whom the Camp has contracted for that purpose. The Camp accepts no responsibility for the performance of these drivers or their equipment. Acknowledgment and Assumption of Risks Camper and Parent understand the activities and risks of the Camp experience, including those described above. Camper and Parent (Parent, for himself or herself and on behalf of Camper), acknowledge and assume all risks of Camper's enrolment and participation in the activities of Camp Genesis, whether or not described above, and inherent or not. Release and Indemnity Parent, for himself or herself, and, to the maximum extent allowed by law, on behalf of the Camper, agrees: a) to release, and not to sue, Camp Genesis, its owners, directors, staff (including volunteers and visiting instructors and clinicians) and independent contractors (each hereinafter a "Released Party") with respect to any and all liability and claims, for property loss, personal injury, death or otherwise, arising in whole or part from Camper's enrolment or participation in Camp activities or presence on Camp premises. b) to hold harmless and indemnify (meaning to protect and pay claims and damages, including costs and attorneys fees) the Released Parties and each of them from and against all claims, by whomever they may be brought (including family members, fellow-campers and others) arising in whole or part from a loss incurred by Camper or caused by Camper related to his or her enrolment or participation in Camp activities or presence on Camp premises. c) These agreements of release and indemnity include, but not exclusively, claims based in whole or part on a Released Party's alleged or actual negligence (but not gross negligence or intentionally wrong conduct). Other a) The code of conduct set out in the Camper/Parent Handbook must be strictly adhered to and Camper may be dismissed from Camp, and sent home, in the event of violations of these or other requirements of the Camp Genesis administration. The rules are for the health, safety and welfare of all the campers and are strictly enforced. b) If a dispute arises between Camper or Parent and the Camp which cannot be resolved by agreement, Parent, for himself or herself and on behalf of the Camper, agrees to submit the dispute for mediation to a mediator registered with or otherwise recognized as such by the High Court of South Africa, Western Cape Division, Cape Town, where such mediation shall be conducted. c) Parent hereby gives permission to Camp Genesis to use photographs, videos or other images of Camper for such purposes as the Camp deems appropriate, including promotional purposes in both print and digital media, and marketing of the camp. d) Parent understands that a non-refundable deposit of R300 is required to secure campers booking. e) The laws of the Republic of South Africa shall govern this agreement and all other disputes between Camper, Parent and the Camp or any other Released Party. Any suit that might be filed against the Camp or any Released Party must be filed only in the High Court of South Africa, Western Cape Division, Cape Town. This agreement shall not be construed for or against a party because that party wrote it.
Checkboxes
*
Camper and Parent have read this agreement carefully and understand its terms.
This form is complete to the best of my knowledge. I have read and agreed to all the terms and conditions. All information contained on this form will be kept on record, however should any information change between now and when your child attends camp please contact us immediately.
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