Mt Waverley January Weekend 2019 Application Form

Please fill in your details carefully.

Personal Details
First Name: Organist:
Surname:
Ecclesia:
Baptised:
D.O.B.
Gender:
Married:
Contact DetailsNext of Kin
Address: Name:
Suburb: Phone Number:
State:
Post Code:
Telephone:
Mobile:
Email:
Dietary Requirements/Medical Conditions: eg asthma, diabetes, epilepsy, allergies etc.
Your application is not complete until we have received your $50 deposit.
Young people under 18 at the time the camp starts will need to send us a paper parental consent form signed by one of their parents.