RYPEN2 - created by phpFormGenerator

Family Name *
Preferred Name *
Sex *
Date of Birth * (In format dd/mm/yyyy)

Age at date of camp
Years *
Months *
Mobile number
Medicare Number *
Email address

HOME DETAILS

Street *
Suburb / Town *
Postcode *
Telephone number

SCHOOL DETAILS

School name *
School address
School postcode *

Telephone
School subjects *

HEALTH AND WELL BEING

Current health issues *
Are you taking any prescribed medications? *

Yes No
If yes, provide details
If medication is prescribed after this form has been submitted please bring to
the seminar an instruction re administration signed by your parent or guardian
Any Dietary Requirements *

Are you a smoker? *
Yes No
If you indicated YES, are you prepared to refrain during the camp?
Yes No

APPLICANT STATEMENT

I understand that I am applying to be considered by the RYPEN South Committee to attend the weekend Seminar
and that I am available to attend from 9:30 am Saturday to 3.30p.m. Sunday and that I acknowledge the essential points
of the Code of Behaviour listed below.-

Code of Behaviour:

Except during organised discussion groups, female quarters are out of bounds to all males and vice versa.
No alcoholic drinks are to be consumed by any person attending the Seminar.
Smoking is not permitted at the camp.
No RYPEN Student may leave the campsite without the knowledge and consent of Chairperson.
If you want to explore the beaches and surrounds, please sign in and out the "BOOK"
"Outside" personal friends of 'Students" not enrolled in the RYPEN Seminar, may not be invited to the campsite.
Lights must be left off in the dormitories after the specified "LIGHTS OUT." Be considerate!
Everyone must attend breakfast and be on time and fully dressed. This is the first organisational session of the day.
Attendance at all sessions is compulsory.
Use of mobile phones. — May only be used to take photos.

By clicking "Submit'' I agree to these conditions.

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