ARE YOU COMPLETING THIS ON BEHALF OF A MINOR? *

Full Name & Surname *

First

Last

Email *

Contact Number *

Gender *

Male
Female
Other

Age *

Any disabilities or medical conditions *

Please specify

Medically diagnosed food allergies or dietary requirements *

Please specify

By completing and submitting this form you are agreeing to the following:

I, being the participant of the applicant (name above) hereby request you to allow me to take part in an excursion to Buffalo Drift during the period reserved. I am aware that neither Camp Genesis or Buffalo Drift accept responsibility for loss, damage or injury to the applicant, or the applicant’s property, which may be sustained during the excursion.

All information collected will be retained strictly in accordance with section 14 of the Protection of Personal Information Act of 2013.

I agree to these terms and conditions

Parent/Guardian Full Name & Surname *

First

Last

Relationship to Minor *

Parent/Guardian Valid Email Address *

Parent/Guardian Contact Number *

Also for emergencies

MINOR'S PERSONAL DETAILS

Minor's Name & Surname *

First

Last

Date of Birth *//

Gender *

Male
Female
Other

Swimming Ability *

Any disabilities or medical conditions *

Please specify

Medically diagnosed food allergies or dietary requirements *

Please specify

EMERGENCY CONTACT

In the event you cannot be reached, please provide an emergency contact.

Emergency Contact Person *

First

Last

Emergency Contact Number *

By completing and submitting this form you are agreeing to the following:

I, being the participant or parent / legal guardian of the minor (name above) hereby consent to him/her attending Camp Genesis to be held at Buffalo Drift where s/he will take part in the outlined programs and activities.

I understand and appreciate the inherent risks and dangers of the location of the campsite, being outside of an urban environment in natural surroundings. I also take note of the fact that there is a dam, river frontage, rocky, uneven and rugged wooded terrain on the premises. I give permission to my child / the child placed in my care, to participate in the programs and activities of Camp Genesis, subject to the following conditions:

1. I accept that the Program organizers, Facilitators and Camp Leaders at Camp Genesis will do everything in their power to be responsible and reasonable to ensure the safety and prevent unnecessary risk of all people on camp and their belongings placed in their care.

2. My child / the child in my care have my permission to participate on and in all activities on camp. Although I understand that every care is taken to ensure his/her safety, I am aware that attendance and participation is all on/at their own risk. I acknowledge and undertake that I have no claim against Camp Genesis, their personnel, contractors or directors on account of death or personal injury of such minor or the loss of or damage to personal belongings of such minor arising from any cause whatsoever and indemnify and hold Camp Genesis, their personnel, contractors or directors harmless against any such claim, demand or liability.

All information collected will be retained strictly in accordance with section 14 of the Protection of Personal Information Act of 2013.

3. My child / the child in my care will obey all the rules of camp and fare instructions from the facilitators and I hereby give consent that my child / the child in my care may be sent home if s/he fails to co-operate or misbehaves or disobeys any of the rules on camp.

Checkbox *

I agree to these terms and conditions