Age: _____ (Sec 1/2/3/4)*
Home Tel. No. __________________________
HP No. ________________________________
Email address: _____________________________________

T-Shirt Size (pls circle): XXS / XS / S / M / L / XL / XXL
Food Allergy:_________________________
Medication Allergy:________________________

The days I’ll be at camp (pls tick):
___ 5 Dec ___ 6 Dec ___ 7Dec ___ 8 Dec
# pls note that day campers will also have to pay full fees

Person to contact in an emergency: ______________________

Contact No. _____________

Camp Fees (inclusive of meals & T-shirt): $ 45 (paid/unpaid)@
@ to be circled by Retreat Committee Members
Financial assistance provided. Pls approach Hannah.


Parental Consent:
I, _____________________________________________ (parent/guardian)* of __________________________________________ allow my child to attend the KS Retreat, held at 50 Jalan Lekar, from the 5 – 8 Dec 2006, and will not hold the Retreat Committee liable to any injuries or damages to personal property incurred throughout the duration of the retreat. I am aware that, in the event that my child misbehaves, he or she may be asked to leave camp.

Signature of Parent/Guardian*: ___________________
Date: ______________