Girls Omatha Retreat 2024 Registration

Student's Name *

First

Last

Which Omatha does your daughter attend? *

Date of Birth *

Year at School (in 2024) *

Parent's Preferred Email Address *

Mother's Name *

First

Last

Mother's Mobile *

Father's Name *

First

Last

Father's Mobile *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Does your daughter have any dietary requirements? *

No dietary requirements
Nut free
Gluten free (intolerance)
Gluten free (coeliac)
Dairy free
Other

Please describe any dietary requirements

Does your daughter have any allergies? *

Is your daughter anaphylactic?

Anaphylaxis action plan

Click or drag files to this area to upload. You can upload up to 2 files.

Please upload anaphylaxis action plan here and bring a hard copy to the camp.

What is your daughter allergic to?

What are the signs and symptoms of the reaction?

How is the reaction usually managed or treated?

Does your daughter have any of the following conditions? If yes, please provide details in the next box

Asthma
Musculoskeletal conditions
Behavioural conditions (e.g. ADHD, ADD, ASD)
Diabetes
Epilepsy or seizures
Headaches or nose bleeds
Heart problems
Language/learning difficulties
Sleep walking

Asthma triggers

Exercise
Pollen
Dust
Grass
Respiratory infection
Other

Please provide details on severity, triggers, and management.

Please upload asthma management plan

Click or drag files to this area to upload. You can upload up to 2 files.

Please describe any other medical conditions not listed above.

Does your daughter take any regular medication? *

Please provide details on medication dosage and frequency. Please ensure medication is supplied in its original packaging and labelled with your child's name. *

Emergency contact name *

Emergency contact mobile number *

Emergency contact relationship to daughter *

The details in this form are confidential. I, being the parent or legal guardian of the above mentioned participant assume full responsibility for her health such that the activities of the program will in no way aggravate any known condition. If in any doubt, I will seek and follow medical advice and inform the Greek Orthodox Christian Society of that advice. I will also notify the Greek Orthodox Christian Society of any significant change in the participant’s health prior to the program. In case of emergency, I give permission for my daughter to be provided any medical treatment necessary by the Greek Orthodox Christian Society. I also expect that all attempts will be made to contact me in any emergency situation. I declare that all statements on this form are true and accurate and that all relevant information has been provided. *

I agree

The cost of the retreat is $350 for first child, $300 for second child, and $150 for any extra children in a family. We kindly ask that all payments are made by 15 December 2023. Please pay via Electronic Funds Transfer to the Greek Orthodox Christian Society (details below) and send a copy of the payment confirmation to your Omatha leader. *

I agree

Account Name: Greek Youth Christian Society BSB: 732 031 Account Number: 070339 Reference: "GOR_DAUGHTER'S NAME"