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Amos 3:3 Application Form    

Surname:

Given name(s):

1)
2)
3)
4)
5)
6)

Address:

Postcode:[numerals only]

Tel:

Mobile:

Cost:

No of people ($70 each):
No of children < 5 y.o.(FREE):

Total Cost: $

Transportation

Do you need transport? Yes No

Emergency Details

1)Contact Name: Tel:
2)Contact Name: Tel:

Under 18 parent/guardian permission:

I give permission for my child(ren)/ward(s) [please enter name(s), separated by commas]

to attend the 2009 ECCC The Covenant Church Camp from 3 – 5 July 2008.

Parent/Guardian Name:

Declaration

By submitting this form, you certify that you either
  1. are above 18 and do not require parental consent

    2. OR
  2. are a parent or guardian submitting this form on the behalf of your child or ward and have completed the "Under 18 parent/guardian permission" section above

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