October 2021 - Online Camp Form Credit Card Payment
  General Enquiries: (03)97379475     Bookings: 0403 271 987, 0418 170 027
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NEW Camp Application Form Card Payment
  1. Which camp are you applying for?(*)
    Please select which camp you are applying for
  2. Select Number of Children in this Application
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  3. Camp Fee - Full Fee or Deposit?(*)

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  4. I will pay the balance of Payment at camp(*)
    Please confirm you will be paying the remainder of your camp fees at camp.
  5. Child Details
  6. First Name:(*)
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  7. Surname:(*)
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  8. Date of Birth(*)
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  9. Gender:(*)
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  10. Grade at School:(*)
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  11. School Attended
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  12. Dietary Requirements:(*)
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  13. Dietary Details:
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  14. Bed Wetting?:
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  15. Medicare Number(*)
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  16. Permission for First Aid to be given at camp as required:(*)
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  17. Permission for Panadol to be given at camp as required:(*)
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  18. Permission for Medical Treatment to be given at camp as required:(*)
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  19. History

    If there is some particular area where you would love to see confidence or self-esteem increased in your child, it would help us to know, so that we can work on that during the camp. Please let us know if your child needs special understanding. All information will be kept private and confidential.

  20. Areas to Work on
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  21. Special Skills, Abilities or Interests:
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  22. Child 2 Details
  23. First Name:(*)
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  24. Surname:(*)
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  25. Date of Birth(*)
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  26. Gender:(*)
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  27. Grade at School:(*)
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  28. School Attended
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  29. Dietary Requirements:(*)
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  30. Dietary Details:
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  31. Bed Wetting?:
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  32. Medicare Number(*)
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  33. Permission for First Aid to be given at camp as required:(*)
    Invalid Input
  34. Permission for Panadol to be given at camp as required:(*)
    Invalid Input
  35. Permission for Medical Treatment to be given at camp as required:(*)
    Invalid Input
  36. History

    If there is some particular area where you would love to see confidence or self-esteem increased in your child, it would help us to know, so that we can work on that during the camp. Please let us know if your child needs special understanding. All information will be kept private and confidential.

  37. Areas to Work on
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  38. Special Skills, Abilities or Interests:
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  39. Child 3 Details
  40. First Name:(*)
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  41. Surname:(*)
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  42. Date of Birth(*)
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  43. Gender:(*)
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  44. Grade at School:(*)
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  45. School Attended
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  46. Dietary Requirements:(*)
    Invalid Input
  47. Dietary Details:
    Invalid Input
  48. Bed Wetting?:
    Invalid Input
  49. Medicare Number(*)
    Invalid Input
  50. Permission for First Aid to be given at camp as required:(*)
    Invalid Input
  51. Permission for Panadol to be given at camp as required:(*)
    Invalid Input
  52. History

    If there is some particular area where you would love to see confidence or self-esteem increased in your child, it would help us to know, so that we can work on that during the camp. Please let us know if your child needs special understanding. All information will be kept private and confidential.

  53. Special Skills, Abilities or Interests:
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  54. Areas to Work on
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  55. Parent / Guardian Details
  56. First Name:(*)
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  57. Second Name:(*)
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  58. Address:(*)
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  59. Postcode:(*)
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  60. Emergency Phone Number(*)
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  61. Alternate Emergency Phone Number(*)
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  62. Permission for Medical Treatment to be given at camp as required:(*)
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  63. Email:(*)
    Please specify your email address.
  64. I understand that by allowing the above children to attend “Kids of Gold” Camp, that all staff and volunteers cannot be held liable for any accidents or injuries that may occur during the duration of the camp.
  65. Sign Here (Type Name):(*)
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  66. Current Total
  67. Grand Total
    0.00 AUD
  68. Payment Method
  69. Total
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  71. PayPal Payment Instructions:

    You do not need to have a PayPal account to pay using PayPal. Instead use the 'Pay with Credit or Debit Card' option as shown highlighted with the red in the example picture below.

    Pay using PayPal

Kids of Gold

A.B.N 57 327 231 835
Registered Incorporated Association No. A0050015Z
 
Registered Address:
323 Monbulk Road
Silvan Victoria 3795

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