Children’s Information and Indemnity Form

Dear Parent/Guardian

This letter serves to confirm that your child will be attending the conference.

Conference Location: Camp Somerset

The camp starts on the 11/04/2024 and ends on the 14/04/2024.

For those needing transport:

Drop Off Date: 11th April 2024

Drop Off Time: 07:30 HRS

Will you be requiring transport to Camp?

Drop-off Point

Please note that your child is encouraged to pack, but not limited to, the following from home:
• Comfortable closed walking shoes such as sneakers
• Warm fleece or Jumpers
• Socks
• Towels
• Pyjamas
• Underwear
• Shorts or longs or skirts
• Medication • Sports Wear
• SUNDAY BEST/ Departmental Uniform
• Toothbrush
• Toothpaste
• Toiletries
• T-shirts

If your child requires anything other than these items, please ensure you send them with him/her.
Mobile phones and other electronic devices:
Upon arrival at camp, Teachers will collect all mobile phones and electronic devices to be stored in a secure environment for safekeeping. FIFMI takes no responsibility for the loss or damage to a client’s personal property, including money or other valuable items. Failure to deposit these devices to teachers and volunteers upon arrival at camp is deemed to be an issue of discipline.
Please rest assured that your child will be in the care of our dedicated team, who will make every effort to ensure that the camp will be a life-changing journey and memorable experience. Whilst all reasonable care will be taken with your child, please we require you to sign the indemnity, failure of which your child may be precluded from attending the camp.
If you have any further questions, please do not hesitate to ask.

You can contact us on:
0416957740 Eld Grace Chifeya
0423329820 Eld Carol Mariano
0420772976 Pastor Mustafa Chikavhu
0403425911 Overseer Joylyn Rusere.

We are very excited that your child will be joining us for this year’s camp.

Yours Faithfully,

Elder Grace Chifeya
Child Evangelism Superintendent QLD

General Information

Child's Names

Child's Surname

Date of Birth

Languages Spoken

School Name

Grade

Home Address

Parent/Guardian Full Name

Parent/Guardian's Email

Emergency Contact Details (minimum of 2 contacts)

Contact 1 Name

Contact 1 Number

Contact 2 Name

Contact 2 Number

Medical Information

Medicare No:.

Expiry Date

Child Position on Card

Private Health Insurance Fund & No

Name & Phone Number of Family Doctor

Medical History

List any food allergies or special dietary requirements your child has

List any medical problems and specify if your child is currently taking any medication

IF YOUR CHILD IS TAKING ANY MEDICATION PLEASE MAKE SURE THAT THEY BRING IT WITH THEM ON THE TRIP TOGETHER WITH DIRECTIONS OF WHEN AND HOW IT SHOULD BE TAKEN

List any physical limitations or restrictions your child may have

List any special needs or requirements (e.g., general behavior, habits at night, etc.)

I give permission to FIMI and their partners to photograph film and use pictures of my child (child’s full name) in media and/or marketing activities.

GENERAL INDEMNITY

I am the parent or legal guardian of the undermentioned child.

I hereby give consent for the undermentioned child to participate in the activities (including, but not limited to sports activities, usage of golf carts, coaching lessons, camps, and educational outings) arranged, organized, or offered by the FIFMI and where relevant, to his/her being transported to and from the said activities by means of transport made available by FIFMI for that purpose.

I further agree that, while reasonable care and precaution will be taken for the safety and welfare of the said child and for the care of their possessions, I indemnify and hold harmless FIFMI and persons acting on its behalf and all other organizations associated with the activities, against any injury or illness, loss, or damage resulting from any cause to the said child during participating in the activities or related transport. Without limiting the indemnity, it will cover all costs, damages, medical costs, and any legal costs and charges.

I furthermore appoint FIFMI and its representatives, accompanying any tour or outing, or supervising the activity, to act in loco parentis in respect of my said child. I further agree that FIFMI and its representatives may arrange for medical treatment should the need arise, and I undertake to pay for such medical treatment and indemnify FIFMI against such costs or expenses.

Consent

Full Name of Child

Full Name of Parent/Guardian

Date

Parent/guardian consent to administer short-term nonprescribed ‘ad-hoc’ medicines.

We will not administer medication unless this form is completed and signed. This information will be kept securely. If further information is needed, we will contact you. Please do not hesitate to contact if there are any issues you wish to discuss.

Child's Name

Date of Birth

Gender

Year / Group

Children will be given a standard dose suitable to their age and weight. You will be informed when they have been administered medication. We will hold a small stock of the following medicines

Paracetamol E45 hand cream Ibuprofen (pupils age 12 and over) Anti-histamine

Method of Communication

Tick the non-prescription medications above that you give your consent for the Teachers to administer during the conference days and confirm that you have administered these medications in the past without adverse effect. Please keep the teachers informed of any changes to this consent.

Consent to administer short-term nonprescribed ‘ad-hoc’ medicines

Parent/Guardian Full Name

Date