Camp Registration

Register Your Child for the Free State Disciplinary Camp

The Free State Disciplinary Camp registration process is designed to ensure the safety, wellbeing, and proper placement of every participant. Parents or legal guardians are required to complete the form accurately and honestly.

Welcome to the Free State Disciplinary Camp registration form.

Only parents/guardians may register for the Free State Disciplinary Camp. Registration requires payment and documents, and all information provided must be accurate and truthful.

Please complete all sections carefully before submitting this Camp Registration for the Free State Disciplinary Camp.

Section 1 - Child Information

Child Full Name *

Child Date of Birth *

Child ID Number *

Child Gender *

Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

City & Zip Code *

Phone Number *

Email Address *

Media Consent for Photos/Videos

I, as the parent/guardian, give consent for my child to be photographed and/or recorded on video during the Free State Disciplinary Camp and for these photos/videos to be used for camp-related media and documentation purposes.

Section 2 - Parent/Guardian & Emergency Contact Information

Parent/Guardian Full Name *

Home Phone *

Work/Cell Phone *

Emergency Contact Name *

Emergency Contact Phone *

Relationship to Child *

Alternate Phone

Section 3- Medical Information

Does your child have any life-threatening health conditions? *

Does your child require anti-drug or chronic medication while at camp? *

If Yes please explain:

Does your child require anti-drug or chronic medication while at camp? *

If Yes please explain:

Section 4- Behavior Information

Briefly explain the behavior or challenges that led you to enroll your child in the camp: *

Layout

Payment Proof

Click or drag a file to this area to upload.

ID card Images

Click or drag files to this area to upload. You can upload up to 5 files.

Parent/Guardian Signature

Click or drag a file to this area to upload.

I confirm that all information provided is true and accurate, I understand the camp rules and structure, I give consent for my child to participate, and I accept responsibility for bringing and collecting my child.

You send this application believing that you allow us to use recordings and pictures taken to be used for our promotional and awareness in Public and Social Media.

To secure your child’s attendance

How to Register

Make payment first

Attach: Proof of Payment Copy of child’s ID, Payment Reference, Use child’s name + age Example: Maggie14

Banking Details

Bank: Standard Bank
Account Name: Free State DC Camp
Branch Code: 051001
Account Number: 10248780253

Send Proof of Payment

📱 WhatsApp:
078 053 1283 , 074 585 2732
📧 Email: sompanem@gmail.com