YOUTH Name *

First Name

Last Name

YOUTH Phone Number

(###)

###

####

Do you have any dietary requirements?

NO dietary requirements

Dairy Free

Gluten Free

Vegetarian

Vegan

OTHER (please let us know)

Parent/Guardian *

First Name

Last Name

Parent/Guardian Phone *

(###)

###

####

Emergency Contact

If different to parent/guardian contact details above

First Name

Last Name

Emergency Contact Phone (if different to parent/guardian contact)

(###)

###

####

Method of payment ($120 per youth) *

Cash or Eftpos (church or youth)

Online (church account: 02-1258-0050667-00)

I need sponsorship

Parent Permission *

I give permission for my child to attend Te Kāinga Youth Camp 2025 at Lakeview Bible Camp in Rotorua. My child understands that there is no drugs, alcohol or weapons allowed at youth camp. I acknowledge that if my child's behaviour does not abide by Te Kāinga Youth guidelines I will be required to pick them up from camp.

I give permission for my child to attend Te Kāinga Youth Camp.