ACC RCL CAMP 2024

16-18 February

Consent form

I, ___________________________________________The Parent/Guardian of: ______________________________________

hereby grant permission that my child may attend the ACC RCL camp at Tevah Venue, from 16 – 18 February 2024 and that
he/she may participate in all activities.

I delegate my authority and responsibility for the duration of the camp to the Facilitator and staff who attend the camp with the
learners, should urgent medical aid be required for the child.

I undertake to pay all Doctor, Hospital and Medical costs which may occur.

To my knowledge he/she enjoys sound health.

The responsible person is required to note the following medical conditions:

__________________________________________________________

Medical aid Information

Main Member (full Name and Surname):_______________________________________________________________________

Medical Aid:
______________________________________________________________________________________________

Home Address:
_____________________________________________________________________________________________

Telephone no:

Home: _____________________ Work: ____________________________ Cell: _____________________

Employer: ______________________________________________________________________________________________

Date of birth of the child:____________________________________________________________________________________

Dependant code on medical aid (i.e.00/0001):

____________________________________________________________________

Allergies: ________________________________________________________________________________________________

Signature of Parent or Guardian: ________________________________