Camp Register

Week Camp

Session 1 Session 2

Camper Information

Camper's Full Name

Nickname/Preferred Name

Address

City

State/Region/Province

Postal / Zip Code

Country

Date of Birth

Gender

Male Female

Place of Birth

Citizenship

Current school

Current grade/year group

Language(s) spoken

Parent Information 1

Parent's Full Name 1

Contact phone number

Line ID

Email Address

Address (if different from applicant)

City

State/Region/Province

Postal / Zip Code

Country

Parent Information 2

Parent's Full Name 2

Contact phone number

Line ID

Email Address

Address (if different from applicant)

City

State/Region/Province

Postal / Zip Code

Country

Emergency Contact

Emergency's Full Name

Relationship to child

Contact phone number

Email Address

Additional Information

Who is financially responsible for the applicant?

Parent 1 Parent 2 Both parents Other

Who does the applicant live with?

Parent 1 Parent 2 Both parents Other

To whom should admission/academic correspondence be sent?

Parent 1 Parent 2 Both parents Other

Health History

Weight (kg)

Height (cm)

Does the applicant have any recent injuries?

Does the applicant suffer from asthma and needs to carry and use a prescribed inhaler?

Yes No

Does the applicant have any other current/on-going illnesses?

Does any treatment need to be continued whilst at the camp?

Yes No

Medical information - please indicate dosage, frequency, specific time to take medication, storage information and any other relevant details

Medication allergies

Food allergies/restrictions (including religious restrictions)

Other allergies (including insect stings, hay fever, animal dander etc.)

Has your child ever had emotional difficulties for which professional help was required?

Yes No

My child is able to participate in an active camp programme

Yes No

Please use this space to provide any additional information about the applicant's behavior, their physical, emotional or mental health or their health care that we should be aware of

Insurance Card
iCamp Thailand highly recommend all campers to be covered by private health and accident insurance.
Please send a copy of the camper's insurance card (front and back) to info@icampthailand.com
Please mark your email subject with 'camper's name' Insurance Card e.g. John Smith Insurance Card

iCamp Drop-off & Pick-up

Transport can be arranged from either of Bangkok's international airports on camp start and end dates. Our pick-up and drop-off location is The Walk Bangna. Pick-up will be at 8.30 am and drop off will be at approximately 11.30am

Do you wish to use iCamp Thailand's transportation to and from Kanchanaburi for the applicant?

No From Bangkok to Camp by iCamp bus (900 THB per person) From Camp to Bangkok by iCamp bus (900 THB per person) Round trip by iCamp bus (1,800 THB per person) Private car pick up at the airport with a chaperone (4,000 THB per trip per person) Private car drop off at the airport with a chaperone (4,000 THB per trip per person) Round trip by private car (8,000 THB per person)

Pick-up Permission
In the case that you or another parent/guardian is unable to make it to collect your child, the following people have permission to pick up my child.

Full Name

Relationship to applicant

Contact phone number

Email address

Photography Permission

I give iCamp Thailand permission to use my or my child's photograph publicly to promote iCamp. I understand that the images may be used in print publications, online publications, presentations, websites and social media.

I agree. You may use images of my child I do not agree. You may not use images of my child

iCamp Apparel

Which t-shirt size does your child wear?

Accident Waiver and Release of Liability

I hereby give my permission for my child to participate in the iCamp Thailand summer camp programme. In consideration of my application and permitting my child to participate in this activity, I hereby: WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the iCamp Thailand, its trustees, officers, employees, camp counselors, volunteers, entitles or other persons released, for my child's death, disability, personal injury, property damages, property theft, or actions of any kind which may hereafter occur to them including their traveling to and from this activity. INDEMNITY, HOLD HARMLESS, AND PROMISE NOT TO SUE the iCamp Thailand, its trustees, officers, employees, volunteers, or other entities or persons release or otherwise. The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. iCamp Thailand, its trustees, directors, officers, and all its employees, acting officially or otherwise are hereby release from any and all claims, demands, actions, or causes of action on account of any injury to my child that may occur. This release binds my heirs, executors, administrators, and/or assigns.

I CERTIFY THAT I HAVE READ THIS DOCUMENT, FULLY UNDERSTAND ITS CONTENT, AND AGREE TO ITS TERMS *

Declaration

The information provided herein is accurate and contains all information requested to the best of knowledge. I have neither omitted nor embellished any facts relating to my child's application.

iCamp Thailand reserves the right to amend or withdraw offers of admission due to mitigating circumstances, changes in information, campers standing or other reasons as determined by the admission.

I give permission for iCamp to provide, seek and consent health care, administrations of prescribed medicine and emergency treatments in event of an emergency and I cannot be contacted. I give permission for iCamp to assist my child at the time of injury including hospitalisation. The information provided herein is accurate and contains all information requested to the best of knowledge. I have neither omitted nor embellished any facts relating to my child's application.

iCamp Thailand reserves the right to amend or withdraw offers of admission due to mitigating circumstances, changes in information, campers standing or other reasons as determined by the admission.

I give permission for iCamp to provide, seek and consent health care, administrations of prescribed medicine and emergency treatments in event of an emergency and I cannot be contacted. I give permission for iCamp to assist my child at the time of injury including hospitalisation. Cancellation and refund policy

REFUND POLICY
- Cancellation request received by iCamp Thailand more than two weeks of the first day of your selected camp, a refund will be offered less a 30% administration fee.
- Cancellations received at least three days before but less than two weeks of the first day of your selected camp will receive a credit voucher towards iCamp Thailand scheduled camp sessions.
- Refunds will not be available for cancellation less than three days of the first day of your selected camp, or once the camp has started.
- In the case of medical or family emergencies, credits will be given for future camp sessions.
- There is no charge to move registration to a different session offered within two months.

I hereby declare that I have filled out this form truthfully. *

I accept the terms and conditions of the cancellation and refund policy. *

Equine Activity Release & Hold Harmless Agreement

*ONLY FOR SUMMER (JUNE-AUGUST). IF APPLYING FOR OTHER SESSION, PLEASE GO TO NEXT SECTION*
**For Campers interested in horse riding**

I have read & understood, and freely & voluntarily enter into this release and hold harmless agreement with iCamp Thailand understanding that this ‘release & hold harmless agreement’ is a waiver of any and all liabilities.

I understand the potential dangers that could incur in mounting, riding, walking, boarding and feeding horses, including but not limited to interaction with other horses. Understanding those risks I heard by release iCamp Thailand its officers, directors, shareholders, employees and anyone else directly or indirectly connected with iCamp Thailand from any liability whatsoever in the event of injury or damage of any nature (or perhaps even death) to me or anyone else caused by or incidental to my electing to mount and ride a horse owned or operated by iCamp Thailand or a 3rd party.

I understand and recognize and warrant that this release and hold harmless agreement, is being voluntarily and internationally signed and agreed to and that in signing this release and hold harmless agreement I know and understand that this release and hold agreement may further limit liability of equine professionals to include any activity whatsoever involving an equine including death personal injury and/or damage to property.

To the best of my knowledge my child is in good health and suffers no disability or conditions which render his or hers participation inadvisable, or otherwise limit his/hers ability to participate in the horse activity without restriction.

Thank you for completing the application form!

We will be in touch soon with information on what to do next. Feel free to contact us if you have any questions. As a reminder, please send the front and back of your child's insurance card to info@icampthailand.com