Adelaide Family Shibir 2021 Registration First Name (required) Sur Name (required) Spouse First Name (required) Spouse Sur Name (required) Your Gender (required) MaleFemale Date of Birth (required) Medicare Id(required) Number of Children (required) 012345 Please state any essential medical/dietary requirements or Allergies Contact Details Email (required) Mobile Number (required) Landline Number Address Suburb City AdelaideSydneyMelbournePerthCanberraBrisbaneWollongongOther State South AustraliaNew South WalesVictoriaWestern AustraliaQueenslandNorthern TerritoryTasmania Country Post Code Emergency Contact Details Parent/Next of Kin Emergency Contact Number 1 Parent/Next of Kin Emergency Contact Number 2 Please credit $65 per Adult and $50 Kids (Ages 5-12 years). Kids under Age 5 free. Hindu Swayam Sevak Sangh, Adelaide Bank: BankSA Limited BSB: 105-900 Account number: 970 633 540 Reference Message: [FirstName]-[LastName] Transaction Receipt Number I understand the risk involved in camp activities. I am aware that the camp participants may use public or private transport during the course of camp activities. I indemnify HSS from any claims arising out of mishap / accident/ injury during the camp stay in or out of camp site.