Sinai Junior Winter Camp

Application Form

Please complete all sections of this form and send it

along with full payment to:

Camp Details:

Sinai Junior Camp,

71 Broughton Avenue
London N3 3EN

Dates: 23rd 30th December 2014

Location: Northamptonshire
Cost: 369
Years: 4-10

Applications will be treated strictly on a first-come first-served basis.

All cheques payable to Sinai Youth Movement Limited.
All applications must arrive by 30th November 2014

Personal Details:
Surname

Address

First Name(s)
Postcode
School Year

Date of Birth

Male/Female

Telephone
Email Address

Medical Details:
Name of GP

Please indicate your childs swimming ability (delete as appropriate):

High(can swim 25m+)/Medium(10m+)/Low(0-10m)/None

Telephone

Will your child require any medication during camp? If yes,

please label any medication brought with name and dosage and
please specify below:

Address

Emergency Contacts (One of which should be

a parent/guardian. Please also state the
contacts relationship to your child):
Does your child have any allergies? If yes please specify:
1. Name
Telephone
2. Name
Telephone

Does your child have any dietary requirements? (e.g. Vegetarian)

Date of Last Tetanus Injection

Please detail any medical condition(s) your child may have:

Sinai Youth Movement Limited 2014

Please detail any other information you feel it may be

appropriate for us to know including any conditions or family
situations that would require your child to receive extra care:

camps@sinaiyouth.org

Terms and Conditions:

1. All details on this form must be accurately and entirely completed to allow the named child to be admitted on to camp. This includes the
disclosure of all medical and other relevant details. Sinai Youth Movement Limited will not be responsible for any form of medical
consequence which may result from failure to disclose relevant information.
2. In the event your child is on medication, you consent to us or the employees of the building or activity providers administering the
relevant medication (including, without limitation, epi-pens if applicable) without obtaining further permission. You also consent to our staff,
building staff or activity provider staff administering first aid to your child if we reasonably believe it is required. We also retain the right to
administer over the counter medication, plasters and similar medical-related items for minor ailments. In the event that your child requires
immediate medical treatment and we are unable to contact you, you authorise the Senior Management Team (SMT) to consent to
emergency medical assistance/treatment on your behalf, which may include the use of anaesthetics.
3. The Camps Committee in conjunction with the executive committee retain the right at any time to refuse any child a place on camp, without
the need to provide any explanation.
4. Payment for camp must be made within the specified time and is not refundable or transferable. All cheques must be made payable to
Sinai Youth Movement Limited.
5. Those who apply for bursaries must do so before the application deadline, and are subject to the specific terms of the bursary, which will
be made known upon the receipt of a bursary application.
6. The Camps Committee in conjunction with the SMT running camp, in their absolute discretion, have the right to send home any child for
any anti-social or unruly behaviour, or for any conduct which the Camps Committee or SMT deem unacceptable and you undertake to make
arrangements at your own expense to collect any child that we send home. In such circumstances payment will not be refunded.
7. All children must comply to the high Halachic standard expected on all Sinai camps. Details of this are available upon request and are
determined by the Camps Committee and SMT on the basis of consultation with the Rabbi of Sinai, Rabbi Alan Kimche. Failure to adhere to this
can result in a child being sent home. In such circumstances payment will not be refunded.
8. Sinai Youth Movement Limited accepts no liability for any property lost, stolen or damaged, regardless of cause. Sinai Youth Movement
accepts no liability for personal injury or the death of any participant unless caused by the negligence of Sinai Youth Movement Limited. All
insurance must be obtained independently.
9. Sinai Youth Movement Limited accepts no responsibility for losses or additional expenses in the event of cancellation or change due to any
event outside the control of Sinai Youth Movement Limited (including without limitation strikes, disasters, war or the threat of war, acts of
terrorism, weather or sickness).
10. Camp staff shall have the right to search every child and their possessions, at any time during the duration of camp for prohibited items.
11. You undertake to compensate Sinai Youth Movement Limited on demand for any damage caused by your child during the course of camp
(whether to buildings, property or otherwise). The compensation amount shall be determined by the SMT acting reasonably and you accept
that where Sinai Youth Movement Limited is required to compensate a third party for such damage, the compensation amount shall be equal to
the amount paid by Sinai Youth Movement Limited to such third party.
12. You consent to us (and/or buildings/activity providers if their terms require this) taking and publishing (whether on our/their website,
in brochures or otherwise) photographs, videos and/or other such media representation of your child during camp
13. Sinai Youth Movement Limited may process the enclosed information for administrative purposes. By signing this form you acknowledge
that this information may include sensitive personal data and you agree to the processing of this information by Sinai Youth Movement Limited
for administrative purposes. All personal data that you provide will be held and processed in accordance with the Data Protection Act 1998.
14. You consent to your child participating in the activities run as part of Machane (including those run by third party activity providers)
15. In the event of a child leaving during the duration of camp, payment will not be refunded, other than in exceptional circumstances and at
the absolute discretion of the SMT.

Sign Off:
Sinai refuses to turn away participants who are unable to attend its camps for financial reasons. To request a
bursary, or for further information, please email: bursaries@sinaiyouth.org
All medical details and bursary applications will be treated in the strictest of confidence.
I, as the parent/guardian of the above named child, give my full permission for the named child to
attend Sinai Junior Camp 2014.
I also consent to, and agree to comply with the terms and conditions set out above.

Print:

Sinai Youth Movement Limited 2014

Signed:

Date:

camps@sinaiyouth.org