CAMPER Application Form Variety NT Adventure Camp CAMPER Application Variety NT Kids Adventure Camp is open to teens aged 13-18 with mild to moderate disabilities and disadvantages. All participants have 3 healthy and hearty meals per day plus morning and afternoon tea and snacks when requested. Campers and rostered carers sleep in large, screened tents under the trees and beautiful starlit sky. The camp aims to allow these amazing teens to enjoy being kids, bring them out of their shell and build their confidence while making friends and memories. Campers are supported 24/7 with round the clock carers, nurse & medical staff as well as volunteers who assist with the cooking and cleaning. All carers and volunteer staff have Working with Children clearances. If you have any questions about completing this form, please reach out to us on 08 8981 2544 or email [email protected] Applications close at midnight on 31 May 2025.BEFORE YOU STARTThis form contains requests for file uploads. Have these ready to go, to make the process easier. You can also Save and Continue by clicking the button at the bottom of the page. Upload Items Checklist Passport style photo of Camper Dr letter detailing medication requirements and other needs need to be aware of (e.g., behavioural concerns). PERSONAL INFORMATIONApplication Submitted By:Name(Required) Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Prefix First Last Mobile Number(Required)Email(Required) Relationship to Camper(Required)ParentGuardianGrandparentFoster CarerOtherOther, please advise(Required)CAMPER DETAILSFull NameDate of Birth(Required) DD slash MM slash YYYY GenderFemaleMaleX / Prefer not to sayT-shirt size(Required)XSSMLXL2XLOther sizeadvise of preferred size(Required)Do you speak any languages other than English?(Required)NoYesPlease list(Required)Do you identify as Aboriginal or Torres Strait Islander?(Required)NoYesAddress(Required) Street Address City Australian Capital TerritoryNorthern TerritoryNew South WalesQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia State Postcode Postal Address is different than above?NoYesPost Address(Required)Has your child attended a Variety Camp at Goanna Park in the past?NoYesWhich year/s?(Required)Please upload a passport style photo of the camper(Required)Max. file size: 512 MB.EMERGENCY CONTACT DETAILSPRIMARY Emergency Contact Name(Required)Relationship to camper(Required)Mobile Number(Required)Alternate or After-Hours contact numberEmail Secondary Emergency ContactSecondary Emergency Contact Name(Required)Relationship to camperMobile Number(Required)Alternate or After-Hours contact numberEmail MEDICAL DETAILSChild's Diagnosis, Special Needs, or Medical Condition:(Required)Medications (including vitamins if taken regularly):(Required)If none, write NilDrug and Environmental Allergies (e.g., Bee Stings):(Required)If none, write NilAttach a doctor's letter detailing medication requirements and other needs need to be aware of (e.g., behavioural concerns).Max. file size: 512 MB.DIETARY REQUIREMENTSDoes your child have any specific food requirements?(Required)NoYesPlease advise(Required)Does your child have any food allergies?(Required)NoYesAllergy details(Required)Non-life-threateningSevere or life-threatening allergiesPlease list allergens and describe the allergic reaction(Required)Are there any drinks your child must avoid?(Required)NoYesPlease list(Required)CARING FOR YOUR CHILD AT CAMPVariety NT will assign a carer to each camper upon arrival. Carers have experience working with children with a disability. Each carer will be responsible for two children where possible and appropriate.Has your child travelled or attended a camp independently before?(Required)NoYesPlease indicate areas where your child is independent:(Required) Toileting Showering Personal Care (brushing teeth, hair etc) Getting Dressed None of the above (requires assistance) Please specify where assistance is required(Required)Does anything make your child upset or afraid?(Required)NoYesPlease specify triggers(Required)Does your child have any specific behavioural issues?(Required)NoYesPlease describe these issues and let us know how can we help manage these behaviours?(Required)Does your child have any sleep-related issues?(Required)NoInsomniaNight terrorsBed wettingSleep apneaPlease tell us about your child's interests and hobbies(Required)Is there anything else we should know to best support your child at camp?(Required)NoYesPlease advise(Required)PARENT/GUARDIAN DECLARATIONDeclaration(Required) I, (type full name below), as the parent/guardian of this applicant, residing at the address listed on this application form, declare that the information provided is accurate to the best of my knowledge.Media Consent (Promotional Material)(Required) I consent to Photo/video content of my child being used for Variety NT promotional materials I do not consent to Photo/video content of my child being used for Variety NT promotional materials Full Name of Parent/Guardian First Last Date MM slash DD slash YYYY Δ
