Register for your camp

camper details

  Male     Female  
  Yes     No  

You must provide a parental consent form.
The parental consent form must be signed by the legal parent or guardian of an applicant under 18 years old. Please scan, or take a clear photo, of the completed form and e-mail to registrar@ywamperth.org.au.


emergency contact


health

Does the camper have a history of any of the following?

  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  
  Yes     No  






  Yes     No  

Cards accepted:

Expiry Month

Expiry Year

The CCV is the last 3 digits printed on the signature strip on the back of the card.

Select program...

This amount includes a 2.7% bank charge.