Maryborough Madness

Application Form
Bookings cannot be made over the phone.
Please send this application form to the
Camp Directors:
address over the page.
Name:____________________________________

Address:__________________________________

________________________P/C_______________
Geoff Parnell Ph: 0412 338 122
Sharon Klein Ph: 0427 771 207
E-mail:maryboroughmadness@suqld.org
It’s on Again!
Mon 21st - Fri 25th
Ph:____________________
September 2009
Mobile:______________________

D.O.B:______/_____/______
Canoeing
School:____________________________________
Waterslide
M ar yb or oug h
Mini Olympics
Grade:______ Male/Female (Please Circle)

a d n es s 2 0 0 9
Parent/Guardian Name _____________________
Father Mother Guardian
Abseiling M
Games
Payment Details: Full Camp fee $115
(Please Tick) Deposit $30 and More!!!
CHEQUE MONEY ORDER
(Please Include the name of the camp on the back of
the cheque) OR All activities, food and transport
CREDIT CARD:
included in camp fee
I authorize SU Qld to deduct my:
Visa MasterCard Amount $_________ and all only $115 !!
Card Number _____________________________ 5 Fun Filled Days for
Name on Card ____________________________
Expiry Date ____/____
Grades 5 & 6
Signature _________________________________
Don’t Miss
Please make Cheques or Money
Orders payable to: Out !!!
Scripture Union Queensland
 Maryborough Madness
Five days of fun, excitement and
great adventures guaranteed.
Abseiling, canoeing, bushcraft,
watersliding, beach activities,
great spiritual programme and
Aldershot Scout Camp-September
more.
Child Protection Statement
of Commitment:
S U Q l d i s c om mi t t e d t o t h e sa f et y a n d ho l i s t i c
w e l l - b e i n g of a l l c hi l dre n a nd y o u ng p eo pl e
i nv o l v ed i n ou r e v e nt s . T o en s u r e t ha t
c h i l d re n a nd y o un g p eop l e a r e k ept sa f e
f r o m ha r m, o u r st a f f a nd v ol u nt ee r s a r e
r e q u i re d t o p o s se s s a cu r r e nt B l u e Ca r d,
a g r ee t o a dh e r e t o a cod e o f co n du ct a nd
u n d e rg o t r a i ni n g i n c hi l d sa f et y. S U Ql d
t a k e s c hi l d p r ot ec t i on a n d sa f et y se r i o u s l y
21st-25th 2009
a n d co n s eq u en t l y h a s po l i c i e s a n d
p r o ce d u re s i n pl a c e t o e n s u r e t ha t y ou r c h i l d
h a s t h e b e st e x p er i en ce s w i t h u s .

Apply early to avoid Parent/ Camper Agreement:

SU Qld holiday camps are conducted
by Scripture Union, a world-wide inter-
denominational organization. Our camps
are staffed by voluntary leaders with a
mix of experienced
and new leaders, all
trained in youth
disappointment!!
A camper letter will be sent to you on
receipt of your application. It will include
more details about the program, a medical
form, what to bring and what not to bring.
ALL forms must be completed and
returned before camp.
I u n de r st a n d t h a t t h e ca m p l ea de r s wi l l t a k e
a l l re a s on a bl e ca r e of m y c h i l d wh i l s t a t
c a mp , b ut t ha t S U Ql d a n d i t s re p re s e nt a t i v e s
w i l l n ot b e l i a b l e f o r a ny i n j u r y o r a c ci de nt ,
o r f o r l o s s or d a m a g e t o pr o pe rt y .
I g i v e m y c o n se nt f o r a n d a g r e e t o pa y f o r
a n y n ec e s sa r y m ed i c a l t r ea t m en t .
I u n de r st a n d t h a t i n ca se of u n a c c ept a bl e
b e h a v i o u r c a m pe r s w i l l b e s e nt h om e f ro m
c a mp .
P a r en t / G ua r di a n N a m e:
___________________________________________________________________________________________

S i g n a t u re :
camping. SU Qld may withhold a late cancellation
Each camp consists fee. ___________________________________________________________________________________________

of a balanced SU Qld reserves the right to reject

program aimed at applications.
meeting physical, Please cut off this section and return to:
social, mental and
Information about our Privacy Policy is Maryborough Madness
spiritual needs.
available at www.suqld.org.au c/-C.O.C
Leaders also pay P.O Box 461,
camp fees. Maryborough 4650