CAMPER Application Form Variety NT Adventure Camp CAMPER Application Variety NT Kids Adventure Camp is open to teens aged 13-17 with mild to moderate disabilities and disadvantages. All participants have 3 healthy and hearty meals per day plus morning and afternoon tea and snacks when requested. Campers and rostered carers sleep in large, screened tents under the trees and beautiful starlit sky. The camp aims to allow these amazing teens to enjoy being kids, bring them out of their shell and build their confidence while making friends and memories. Campers are supported with carers, a nurse/ medical support as well as volunteers who assist with the cooking and cleaning. All carers and volunteer staff have Working with Children clearances. If you have any questions about completing this form, please reach out to us on 08 8981 2544 or email [email protected] Applications close at midnight on 22 May 2026.BEFORE YOU STARTThis form contains requests for file uploads. Have these ready to go, to make the process easier. You can also Save and Continue by clicking the button at the bottom of the page. Upload Items Checklist Passport style photo of Camper Dr letter detailing medication requirements and other needs need to be aware of (e.g., behavioural concerns). PERSONAL INFORMATIONParental/Guardian Name:(Required) Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Prefix First Last Mobile Number(Required)Email(Required) Relationship to Camper(Required)ParentGuardianGrandparentFoster CarerOtherOther, please advise(Required)CHILD / CAMPER DETAILSFull NameDate of Birth(Required) DD slash MM slash YYYY Gender(Required)FemaleMaleX / Prefer not to sayT-shirt size(Required)XSSMLXL2XLOther sizeAdvise of preferred size(Required)Address(Required) Street Address City Australian Capital TerritoryNorthern TerritoryNew South WalesQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia State Postcode Postal Address is different than above?NoYesPost Address(Required)Which year/s?(Required)Please list(Required)EMERGENCY CONTACT DETAILSPRIMARY Emergency Contact Name(Required)Relationship to camper(Required)Mobile Number(Required)Email(Required) Secondary Emergency ContactSecondary Emergency Contact Name(Required)Relationship to camper(Required)Mobile Number(Required)Email(Required) MEDICAL DETAILSChild's Diagnosis, Special Needs, or Medical Condition:(Required)Medications (including vitamins if taken regularly):(Required)If none, write NilDrug and Environmental Allergies (e.g., Bee Stings):(Required)If none, write NilAttach a doctor's letter detailing medication requirements and other needs need to be aware of (e.g., behavioural concerns).Max. file size: 128 MB. DIETARY REQUIREMENTSDoes your child have any specific food requirements?(Required)NoYesPlease advise(Required)Does your child have any food allergies?(Required)NoYesAllergy details(Required)Non-life-threateningSevere or life-threatening allergiesPlease list allergens and describe the allergic reaction(Required)Are there any drinks your child must avoid?(Required)NoYesPlease list(Required)CARING FOR YOUR CHILD AT CAMPVariety NT will assign a carer to each camper upon arrival. Carers have experience working with children with a disability. Each carer will be responsible for two children where possible and appropriate.Has your child attended a Variety Camp at Goanna Park in the past?(Required)NoYesHas your child travelled or attended a camp independently before?(Required)NoYesDo you speak any languages other than English?(Required)NoYesDo you identify as Aboriginal or Torres Strait Islander?(Required)NoYesPlease let us know if there are any cultural or regious needs we should be aware of to support your child.NoYesPlease indicate areas where your child is independent:(Required) Toileting Showering Personal Care (brushing teeth, hair etc) Getting Dressed None of the above (requires assistance) Please specify where assistance is requiredActivities include walking, swimming, playing games, art and craft and going on excursion. Please let us know if your child can do the following: Walk over 1 kms without assistance Able to swim 25 metres without assistance Activities include walking, swimming, playing games, art and craft and going on excursion. Please let us know if your child is able to walk over 1 kms without assistanceDoes anything make your child upset, anxious or afraid?(Required)NoYesPlease specify triggersDoes your child have any specific behavioural issues?(Required)NoYesPlease describe these issues and let us know how can we help manage these behaviours?(Required)Does your child have any behaviors that may affect their safety or safety of others?(Required) Wandering or running away Difficulty recognising danger Physical or emotional outbursts Self-harm behaviours None Does your child require additional support for any of the following?(Required) Following instrutions Social interacting with other people Managing emtions or frustration Staying with the group None Does your child have any sleep-related issues?(Required)NoInsomniaNight terrorsSleep walkingBed wettingSleep apneaPlease tell us about your child's interests, hobbies or favourite activities.(Required)Is there anything else we should know to best support your child at camp?(Required)NoYesPlease advisePlease upload a passport style photo of the camperMax. file size: 128 MB. PARENT/GUARDIAN DECLARATIONDeclaration(Required) I, (type full name below), as the parent/guardian of this applicant, declare that the information provided is accurate to the best of my knowledge. I understand that this information will be used to assess my child's suitability for the camp and to ensure appropriate care and support during the camp.Media Consent - please let one(Required) I consent to Photo/video content of my child being used for Variety NT promotional materials I do not consent to Photo/video content of my child being used for Variety NT promotional materials Full Name of Parent/Guardian First Last Date MM slash DD slash YYYY Δ
