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SummerCamp booking FORM

Eco Kid Adventure

SummerCampBooking FORM

* excluding transport.

Participant Detail

Name:
Email:
Telephone No:
Fax. No:
Age:
Date of Birth:
Gender:
Nationality:
Birth Cert/IC No:
Postal Address:

Parents Information

Name of Parent/Gurdian:
Passport/IC No:
Mobile Phone No:
Office Tel. No:
Fax No:
Occupation:

Child Interest and experience

Note

Health Declaration Form

Please read through carefully this health declaration form and answer these questions
honestly and to the best of your knowledge.

Any health or medical condition that requires attention?

Any drug/food/drink allergies?

Has the participant ever attended such camp?

Any skills. eg.First aid skills etc?

Designated Camp : Date Program :

Other Needs

Parents Declaration & Aggrement

I/we the parent and/or legal guardian of name of child understands that the above registration involves the following commitment to our part: The total fees for all the designated summer camp program, food & beverages,lodginh, facilitators,instrcutors and course materials for the Summer Camp amounting to RM shall be deposited into the account of ECO KID ADVENTURE or into BANK PERTANIAN MALAYSIA. A/C NO 1031-000-3181 three (3) working days before the date of the camp program. I/we believe that my/our child is qualified for camp life and hereby give full permission for my/our child/children to take part in all the indoor and outdoor activities organized by Eco Kid Adventure and also agree to place him/her in the care of the camp, subjected to its rules and regulation.In any case of an emergency, that involve the participant from the nearest available qualified medical practitoner, clinic or hospital. In case of mediacal emergency that need immediate surgey we hereby authorized and given permission to the physician selected by the Camp Director to hospitalise, order injection, anaesthic and perform emergency surgery. I/we also agree that in case of any misconduct of my child/children, that could endanger other participants, Eco Kid Adventure or its authorized agents have the right to decide on the possibility of sending the my/our child/children home at our own cost.

Date : Cheque No :

Agree : Yes No

 Payment  Details

Cheque Payable to: 
ECO KID ADVENTURE or into BANK PERTANIAN MALAYSIA (a/c no : 1031-000-3181)

please send/fax us a copy of the bank-in slip once you bank in to our account as proof of payment

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