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Pathways
into Womanhood Registration
Pathways to Womanhood Registration Form
IMPORTANT INFORMATION for all parents and caregivers
Congratulations on choosing to attend this Program! It is vitally important that all parents/carers read and understand all the enclosed information. PLEASE NOTE that it is a requirement of the Pathways Program that you read, complete and sign the below forms. It is our policy that this must be done to ensure your daughter's acceptance to the Program.
Name of attending girl
*
Date & Location
*
Name (Guardian 1)
*
First
Last
Name (Guardian 2)
Leave blank if not applicable
First
Last
PAYMENT TERMS
Pathways Foundation Payment Terms and Refund Policy Please note that Pathways Foundation is a non-profit organization. We incur a lot of overheads to run our camps and aim to keep costs for participants as low as possible. We often have waiting lists for our camps AND it is very difficult to fill places at short notice. For this reason, we have the following payment terms and refund policy:
1.
The cost of the Pathways to Womanhood Camp is $2,400. A Camp deposit of $600 is required to secure your place on the Camp at the time of registration.
2.
The Camp deposit paid as part of your registration process is NON REFUNDABLE unless the Camp is cancelled by Pathways Foundation when the deposit and other paid Camp fees will be refunded.
3.
You are required to pay the balance of your Camp fees 6 weeks prior to the commencement of the Camp.
4.
If you cancel your booking 8 weeks or more prior to the commencement of the Camp:
4a.
You may transfer your deposit and other paid Camp fees to another scheduled Camp.
4b.
You may ask for your deposit and other paid Camp fees to be held until you nominate another Camp to transfer your fees to. Your paid fees will be held for a maximum of 12 months from the time of cancellation, after which the fees will no longer be transferable and will be treated as a cancellation fee by Pathways Foundation.
4c.
You may ask, at the time of cancellation, for your paid Camp fees other than your nonrefundable deposit to be refunded.
5.
If you cancel your booking less than 8 weeks prior to the commencement of the Camp the deposit and other paid Camp fees will be NON REFUNDABLE and treated as a cancellation fee UNLESS there are extenuating circumstances leading to the cancellation when the deposit and Camp fees MAY be treated as transferable on the approval of the Operations Manager. Please provide Pathways foundation with a written request detailing the circumstances of your cancellation.
6.
Please refer www.pathwaysfoundation.org.au to ensure you have the latest registration form and terms. Prices may be subject to variation.
7.
If you require financial assistance please download the "Financial Assistance Package" from our website. Please send us this form with your request for financial assistance.
I have read and understood these payment terms and conditions.
*
Yes
No
REGISTRATION FORM
Name of attending girl
*
First
Last
Date of birth
*
DD
MM
YYYY
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
What are the current living arrangements of the girl participating?
*
Lives with:
Mother
Father
Both Parents
Name of current school
*
Where did you hear about the Pathways to Womanhood program?
*
ACCOMPANYING FEMALE
Name of accompanying Female/Mother
*
First
Last
Relationship (to attending girl)
*
Date of birth
*
DD
MM
YYYY
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
*
Email
*
Note: A copy of this filled-in form will be sent to this email after completion
As the accompanying Female/Mother, do you have any medical condition that would make it difficult for you to take part in gentle morning exercises?
*
Yes
No
Do you have any medical condition that we need to be aware of or are you on any medication?
*
Yes
No
Please give details of any medical conditions we may need to be aware of:
Do you have any dietary needs?
*
Yes
No
Please give details of your dietary needs:
Emergency Contact (Name)
*
First
Last
Emergency Contact (Phone)
*
FATHER/ACCOMPANYING MALE
If applicable
Name of Father/Accompanying Male
*
First
Last
NOTE: The Father/Accompanying Male fields must be completed as he is an essential part of this program and his details are essential.
Relationship (to attending girl)
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
*
Email
*
MEDICAL FORM (ATTENDING GIRL)
Does the attending girl have any dietary needs?
*
Yes
No
Please give details of any dietary needs:
Does the attending girl have any medical conditions that we need to be aware of or is she on any medication?
*
Yes
No
Please give details of any medical conditions we need to be aware of:
Please give details of any specific medication we may need to be aware of:
Does the attending girl suffer from:
Fits of any kind
Dizzy spells
Travel sickness
Heart condition
Sleep disorders
Disability
Diabetes
Blackouts
Recent or recurrent illness
Migraine
Epilepsy
Mental health
Is there any other information relating to physical or mental health and wellbeing we need to know about?
Has the attending girl started menstruating?
*
Yes
No
How long has she been having periods?
*
Does she know about menstruation?
*
Does the attending girl suffer from any allergies or asthma?
*
Yes
No
ALLERGY/ASTHMA FORM
What may trigger an allergic reaction?
Insect bites
Plant pollens
Plants
Food groups or additives
Penicillin
Foods
Animals
Detergents or cleaning agents
Drug allergies (please specify)
Other allergies (please specify)
What are the signs and symptoms of her reaction?
What may trigger an asthmatic reaction?
Example: (food, exercise, cold weather, pollen)
What are her usual symptoms?
Example: (wheezing, coughing, tightness in chest, difficulty breathing, other)
PARENTAL / CAREGIVER CONSENT FORM
I/we being the parent/guardian of the above-mentioned attending girl declare that I/we understand that the activities may involve running, jumping, dancing and water thus exposing my/our girl to situations and physical activity not encountered in a classroom.
I/we acknowledge that while
Pathways
and its staff will make every reasonable effort to minimise exposure to known risks, all hazards and dangers associated with these activities cannot be foreseen or may be beyond the control of
Pathways
and its staff.
I/we hereby indemnify
Pathways
and its staff against any claim for accident or injury to my/our child during the course of the program.
I/we understand that my/our girl’s involvement in the
Pathways
program may mean that she is remote from immediate medical help. I/we have provided
Pathways
with enough written information to deal appropriately with the attending girl’s medical condition
I/we further authorise
Pathways
, in the event of any injury or illness, and where it is not possible or reasonable to obtain my/our consent at the time, to engage a Medical Practitioner, Ambulance or hospital facilities. In this event I/we agree to pay all such emergency evacuation, Ambulance, Doctor, Nurse and /or hospital expenses.
I/we have read the Frequently Asked Questions and other accompanying documents, and understand the level of involvement required of me/us.
Participants will, at times, be engaging in physical and emotional processes. Full disclosure of any prior or existing conditions is required.
I/we have provided all information relating to physical or mental health and well being.
I have read, understand and agree to the consent form
*
Yes
Name of accompanying woman (parent/guardian)
*
Name of accompanying man (parent/guardian)
*
