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Campers full name (required)

Contact E-mail address for confirmation (required)

Date of Birth (required)

Gender (required)
---MaleFemale

House number and street (required)

Adress Line 2

Town (required)

County (required)

Postcode (required)

Phone (required)

Mobile (required)

Which camp does your child wish to attend?
---Junior Inter Senior

Name of first friend to be in same tent as (if possible)

Name of second friend to be in same tent as (if possible)

Do you have any special DIET needs (eg vegetarian/allergies?) If none, please type 'none' If 'yes' please provide details (required)

Do you have any special MEDICAL needs (eg medical condition/medicines/allergies?) If none, please type 'none' If 'yes' please provide details (required)

Do you have any special EDUCATIONAL/EMOTIONAL needs? If none, please type 'none' If 'yes' please provide details (required)

Doctor's Name (required)

Doctor's Address (required)

Doctor's Telephone (required)

Name of Emergency Contact during camp (required)

Emergency Contact Phone number (required)

Relationship to camper (required)

Name of Church or Youth Group you attend?

Church Leader Contact details:

By checking this box I confirm I have read the SHBC Information Leaflet or have read information about Camp on the Website. The person applying is fit to attend Camp and is able to participate in all activities including swimming (unless otherwise indicated above or in separate information). She/He will abide by Camp rules. If required, I agree that first aid and/or medication may be given, and in the event of an emergency, medical treatment may be sought."

I agree to the above Statement 

 I give permission for Photographs of my child to be used for publicity purposes

I do not give permission for Photographs of my child to be used for publicity purposes 

Please enter payment amount here (required)

Please enter your payment reference number here (required)

How did you hear about South Hants Bible Camps?
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