Register for Step 1 of 2 50% Event(Required)2024 ESA Lake Tyers Teen CampSample Camp 2Ticket type(Required)Camper (150 items remaining)Volunteer (75 items remaining)Staff (25 items remaining)ESA Kids (25 items remaining)ESA Spouse (25 items remaining)Camper Waitlist (2 items remaining)HiddenEvent Start Date Access code(Required)Please input a valid access code for your ticket type Attendee DetailsIs the attendee over 18 years of age ?(Required) Yes No This registration needs to filled out by an adultAttendee – Name(Required) First name Last name Attendee Email(Required) Attendee Phone(Required) Attendee Address(Required) Street Address Suburb State Postcode Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Attendee Gender(Required) Attendee Date of Birth(Required)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Attendee Current School Year Level(Required)456789101112Has this attendee been on an ESA camp before?(Required) Yes No Wed love to know, how did you hear about this camp?(Required)Your answer helps us figure out the best ways to spread the word about ESA! ESA Website My local church From an ESA Representative or Pastoral Worker Through a friend/family member Emails from ESA Facebook Instagram The Radio School Newsletter Other Does this attendee regularly attend a church?(Required) Yes No Which church is this attendee's home church?(Required) ESA has a zero tolerance of child abuse. Please confirm your agreement to the following statement:(Required) I have never been convicted or investigated for sexual abuse, assault or a sexual offence of any kind. (If you are unable to confirm your agreement to this statement, please do not proceed with your registration and contact our Child Safe Officer via 9837 5225 or cberryman@esa.org.au)Working with Children CheckWWCC Number(Required) WWCC Expiry Date(Required) DD dash MM dash YYYY WWCC Type(Required) Employee Volunteer Please upload an image of your WWCC(Required)Max. file size: 128 MB.Is this Attendee Anaphylactic?(Required) Yes No Does this Attendee have any Allergies?(Required) Yes No Does the attendee have any medical condition or special needs?(Required) Yes No Please list conditions, needs and/or allergies.(Required)Is there any information we need to know to support this attendee on camp?Please include any management plans in relation to medical conditionsWill this Attendee require any medication while on camp?(Required) Yes No What type of medication does this attendee require?(Required)Please list the medication name and dosage the attendee will require on campWill a support worker/carer be attending camp with this attendee?(Required) Yes No Please contact camps@esa.org.au to arrange the ticket for this attendee's support worker/carer.(Required)You will be contacted by the ESA representative on this camp to discuss the campers needs and support workers role in more detail. I agree to contact camps@esa.org.auDoes this Attendee have any Dietary Requirements?(Required) None Nut Allergy Gluten Free Vegetarian Vegan Dairy Free Lactose Free Other Attendee's Medicare Card Number(Required)Including the number next to attendee’s name Attendee's Medicare Card Holders Name(Required) Does this Attendee have ambulance cover?(Required) Yes No In the case your child becomes unwell, ESA will endeavor to contact you prior to administering medication. However, in an emergency, does the parent/guardian give permission for this Attendee to be given Panadol(Required) Yes No In case of emergency and if the parent/guardian/emergency contact person is uncontactable, the parent/guardian gives their consent to authorise emergency medical arrangements on their behalf as deemed necessary by a qualified medical practitioner.(Required) I agreeIn case of emergency this attendee gives their consent to authorise emergency medical arrangements as deemed necessary by a qualified medical practitioner.(Required) I agreeIn the unlikely case that camp attendees need to be transported off site, you agree that this camper can be driven in a fully licensed leader's car.(Required) I agreeEmergency Contact 1(Required) First name Last name Emergency Contact 1 – Relationship(Required) Emergency Contact 1 – Phone Number(Required) Emergency Contact 2(Required) First name Last name Emergency Contact 2 – Relationship(Required) Emergency Contact 2 – Phone Number(Required) Is there anyone this attendee would like to share a room with? As a volunteer on an ESA Camp, it is a requirement that you read and agree to abide by the following documents. Please complete below. ESA Child Safe Policy ESA Code of Conduct Statement of Faith ESA’s Assumption of Risk ESA’s Cancellation Policy ESA’s Photography Statement As a volunteer on an ESA Camp, it is a requirement that you read and agree to abide by the following documents. Please complete below.(Required) I have read the above documents(Required)Parent/Guardian DetailsParent/Guardian – Name(Required) First name Last name Parent/Guardian Mobile(Required) Parent/Guardian Email(Required) Payment DetailsHiddenTotal HiddenCredit Card(Required)Please check your Stripe API Settings. Click the "Connect with Stripe" button to use Stripe. Total
