Eagles Application

Name*

First Surname

Email*

Your Age*

Have you completed Grade 12?*

Yes
No

Phone*

Gender*

Male
Female

ID Number*

Address*

Occupation*

Medical Aid*

I don't have a medical aid
I have medical Aid

Medical Aid Name*

Medical Aid Number*

Medical Aid contact number*

Main member on medical aid*

Contact person in case of an emergency*

Emergency Contact Phone Number*

Where did you hear about Camp Escape?*

Have you ever been an eagle before?*

Have you been a camper at CE?*

When would you like to come for your interview?*

T&C*

I read and understood the costs involved. I am also aware of the dates I need to be available for the eagles camp | meetings etc. I have read and agree with the rules and dates given.

Yes
No

Disclaimer*

I hereby confirm that to the best of my knowledge there are no accusations or indictments against my name of any sexual (or other) nature which would deem me a risk to minors, disqualify me from standing in this capacity or compromise the emotional wellness and physical safety of the children and adults on this camp.

Yes
No

Signature*

Use the digital pen to sign below

Every person involved with Camp Escape will need to apply for a Police Clearance Certificate at their own cost. (R120)*

I understand

Did you pay your Admin fee?*

Yes
No

Please upload your proof of payment below.*

General comments about your application

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Eagles Application

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