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Registration Form
*NB: Please read: AWOL Camp Info before filling in this registration form PERSONAL INFORMATION:
PLEASE COMPLETE THIS FORM USING BLOCK (CAPITAL) LETTERS

Surname: __________________________________ First Name: ____________________ Greeting Name (nickname): ___________________ Birth date (dd/mm/yy): ___/___/______ Gender:
Male Female

Race:

African

Coloured

Indian

White

Other

What Grade are you currently in?: _____ Age: ____ School: ________________________ Parent/Guardian Name & Surname: ___________________________________________ Parent/Guardian Cell #: ___________________ Home #: ____________________
(The above cell number will be used for information smss during AWOL.)

Teen Cell #: ___________________ E-mail: _____________________________________ T-shirt size: S M L XL XXL XXXL Yes No

Do you suffer from any allergies or medical conditions?:

If Yes please describe:___________________________________________________ ______________________________________________________________________ Any special dietary needs? Yes No.

If Yes please describe:___________________________________________________ ______________________________________________________________________ Emergency contact person (other than parent/guardian above): Name & Surname _______________________________________ Contact #: __________________ CHURCH INFORMATION: Churchs name: ___________________________________________________________ Churchs Phone #: ____________________ Town of Church: ______________________ Name of Youth Leader (or Church Leader):______________________________________ Are you booking together as a church/youth group?: Yes No

If Yes, Name of group: __________________________________________________

2012

www.aworkoflove.co.za

registration@aworkoflove.co.za

phone: 035 772 6095 / fax: 086 573 3418

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*NB: Please read: AWOL Camp Info before filling in this registration form CAMP INFORMATION: If you are unable to bring/share a tent, a few communal tents are provided at a cost of R40.00. Do you need to make use of the communal tents?: When are you planning to arrive?: Yes No

Sunday, 1 July (3:00pm to 6:30pm) Monday, 2 July (7:00am to 8:00am)

If you are arriving Sunday, would you like supper at a cost of R30.00 (payable at the canteen)?: Drama Team, Yes No Music Team Art and/or Sports Ministry Some outreaches will require specific talents. Would you like to participate in: Dance Team Note: There is no guarantee that you will be placed in any of the above groups PAYMENT INFORMATION (payment receipt MUST be attached to last page): To secure your place, you must pay your deposit BEFORE submitting this form. What amount are you paying?: Deposit: R200.00 (The balance is due on arrival) Full amount (no communal tent): R400.00*. Full amount (using communal tent): R440.00*.
* Under certain circumstances, sibling discounts may be granted. (Your church pastor or youth leader will need to contact us.)

PLEASE USE CORRECT REFERENCE ON YOUR DEPOSIT: Your reference is your surname followed by your first name (eg: JAMESON PETER)

Date of bank deposit (dd/mm/yy): ___/___/_____ Reference on your deposit slip: ______________________ RULES:
I understand and will abide by the AWOL Camp Rules as stated in the AWOL Camper Info document.

Banking Details

Bank: FNB Empangeni Branch: 220 130 Acc Name: A work of love Account: 62 260 616 027

________________________ Teen name

____________________ Teen signature

__________ Date

INDEMNITY:
I, the parent/guardian of the above child do hereby consent to his/her participation in AWOL and do hereby declare that I understand the conditions set out herein and that I agree to abide by the conditions stated below: I agree that should the above child disregard the AWOL Camp Rules, he/she may be dismissed from the camp. In the event of illness or accident requiring emergency hospital treatment, I authorise the designated AWOL leaders on duty, to sign on my behalf any written form of consent required by the hospital authorities, if the delay required to obtain my own signature is considered inadvisable or unnecessary by the doctor or surgeon concerned. (Delete this clause if desired.)

2012

www.aworkoflove.co.za

registration@aworkoflove.co.za

phone: 035 772 6095 / fax: 086 573 3418

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AWOL and the associated churches employees, servants, volunteers, representatives and/or agents shall not be liable for any loss and/or damage in any circumstances whatsoever arising from and in respect of my childs death, injury, loss and/or damage to person and/or property, howsoever caused and howsoever arising. I hold harmless and indemnify AWOL and the associated churches employees, servants, volunteers , representatives and/or agents, against any claims of whatsoever nature, including costs and expenses in respect of my childs death, injury, loss and/or damage to person and/or property irrespective of whether such death, injury, loss and/or damage to person and/or property may have been caused by an act or omission, whether negligent or otherwise, of any such employee, teacher or volunteer, representative and/or agent of AWOL and the associated churches. I give permission for AWOL to use any photo, video or interview taken during the event to be used to illustrate report, promote or advertise the ministry of AWOL.

________________________ Parent/guardians name HOW TO PROCESS YOUR FORM:

____________________ Parent/guardians signature

__________ Date

Please attach proof of payment to the bottom of this page before submitting your form. Your form can then be faxed to: 086 573 3418. Alternatively, your form can be handed in at Richards Bay Baptist Church or Empangeni Methodist Church. Once your registration has been processed, you will receive an sms confirmation to your cell phone (If you do not have one, the confirmation will be sent to your parents cell phone.) PLEASE only phone the office after 3 working days from the date of your fax if you have not yet received your sms. (Direct phone line to the registration office is 035 772 6095, or email: registration@aworkoflove.co.za)

RECEIPT OF PAYMENT:

2012

www.aworkoflove.co.za

registration@aworkoflove.co.za

phone: 035 772 6095 / fax: 086 573 3418