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INSTRUCTIONS
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Step 1.Please keep a copy of this page for your records..
Step 2. If you have any questions or concerns, or you need to amend the medical information you submitted during your online registration, please contact us via email at This email address is being protected from spambots. You need JavaScript enabled to view it..
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SUMMARY OF DETAILS
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| First Name: |
[FIRSTNAME] |
| Last Name: |
[LASTNAME] |
| Gender: |
[GENDER] |
| Date of Birth: |
[DATE_OF_BIRTH] |
| School: |
[SCHOOL][SCHOOL_OTHER] [SCHOOL_NBSC_CAMPUS] |
| Contact Email: |
[EMAIL] |
| Home Address: |
[STREET_ADDRESS], [SUBURB] |
| State: |
[STATE] |
| Postcode: |
[POSTCODE] |
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Emergency Contact Details
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| Primary |
| Name: |
[EMERGENCY_NAME_PRIMARY] |
| Relationship: |
[EMERGENCY_RELATIONSHIP_PRIMARY] |
| Mobile / Alternative Phone: |
[EMERGENCY_MOBILE_PRIMARY] / [EMERGENCY_OTHERPHONE_PRIMARY] |
| Secondary |
| Name: |
[EMERGENCY_NAME_SECONDARY] |
| Relationship: |
[EMERGENCY_RELATIONSHIP_SECONDARY] |
| Mobile: |
[EMERGENCY_MOBILE_SECONDARY] |
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MEDICAL DETAILS
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| Medicare Number: |
[MEDICARE_NUMBER] |
| Medicare Number on Card: |
[MEDICARE_INDIVIDUALS_NUMBER] |
| Medicare Expiry Date: |
[MEDICARE_EXPIRY] |
| Private Health Fund: |
[PRIVATE_HEALTH_INSURANCE_NAME] |
| Health Fund - Number: |
[PRIVATE_HEALTH_INSURANCE_NUMBER] |
| Suffer from Asthma: |
[MEDICAL_ASTHMA] |
| Asthma condition: |
[MEDICAL_ASTHMA_SEVERITY] |
| Asthma details: |
[MEDICAL_ASTHMA_TREATMENT] |
| Suffer from any Allergies: |
[MEDICAL_ALLERGIES] |
| Allergies Condition: |
[MEDICAL_ALLERGIES_SEVERITY] |
| Allergies treatments: |
[MEDICAL_ALLERGIES_TREATMENT] |
| Other medical condition: |
[MEDICAL_OTHER_DETAILS] |
| Dietary requirements: |
[MEDICAL_DIETARIES] |
| Other dietary requirements: |
[MEDICAL_DIETARIES_OTHER] |
| Tetanus current: |
[MEDICAL_TETANUS] |
| Confidently swim: |
[MEDICAL_SWIM] |
EQUIPMENT - Please click here for a copy of the Equipment List.
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HIRED
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[DEAS_EQUIP_HIRE_BRONZE] [DEAS_EQUIP_HIRE_SILVER] [DEAS_EQUIP_HIRE_GOLD] [EQUIP_HIRE_BRONZE_NOTENTS] [EQUIP_HIRE_SCHOOLCAMP]
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PURCHASED
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[EQUIP_PURCHASE_HEADTORCH_TICK] [EQUIP_PURCHASE_WATERBOTTLE_TICK] [EQUIP_PURCHASE_RAINJACKET_TICK] [EQUIP_PURCHASE_FOAMMAT_TICK] [EQUIP_PURCHASE_SI_MAT_TICK] [EQUIP_PURCHASE_SLEEPING_BAG_TICK] [EQUIP_PURCHASE_SLEEPING_BAG_LINER_TICK] [EQUIP_PURCHASE_THERMAL_TOP_TICK] [EQUIP_PURCHASE_THERMAL_BOTTOM_TICK] [EQUIP_PURCHASE_TRAVEL_TOWEL_TICK] [EQUIP_PURCHASE_HYDRATOR_TICK] [EQUIP_PURCHASE_RUCKSACK_TICK] [EQUIP_PURCHASE_MAPCASE_TICK] [EQUIP_PURCHASE_COMPASS_TICK] [FREEZEDRIED_LAMB_TICK] [FREEZEDRIED_LAMB_QTY] [FREEZEDRIED_CHICKEN_TICK] [FREEZEDRIED_CHICKEN_QTY] [FREEZEDRIED_BEEF_TICK] [FREEZEDRIED_BEEF_QTY] [FREEZEDRIED_VEGO_TICK] [FREEZEDRIED_VEGO_QTY]
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