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ABBOX SONY FOUNDATION CHILDREN'S HOLIDAY CAMP 2023

Application form for completion by parents.

Camp dates: 8-10 December 2023

BASIC INFORMATION

Child's First Name *

Child's Middle Names

Child's Surname *

Please state if your child has previously been known by another name *

Child's Address *

Child's Gender *

Date of birth *

Place of birth *

Child's age (Number) *

Child's height *

Child’s Care Status (parental responsibility) *

Child’s disability *

Has your child spent a night away from you in the past? *

Have you applied for any other Children’s Holiday Camps this year? *

Please state which camps: (E.g., St Joseph’s, Riverview)

Do you have regular respite? If yes how often? *

ABOUT YOUR CHILD

Please briefly provide details about your child and their needs *

Does your child have regular access to respite? If so, please provide details on type and frequency. *

How is your child matured? *

Has your child attended a Sony Camp before? *

What is your primary reason for applying for your child to attend camp? *

What are three of your child’s likes/ favourite things? I.e., toys, places, activities, songs, topics to talk about? *

What are your child’s favourite social activities? *

What are your child’s favourite leisure activities? *

What are three things your child dislikes? *

Does your child have siblings, other family members or informal supports/ carers that they regularly spend time with? *

Is your child verbal? If not, what non-verbal aides does your child use? *

How much of what is being said does your child understand? *

How does your child communicate when they are hungry, upset, happy, tired, angry? *

Has your child reached puberty? If female, have they commenced menstruation and do they know how to manage their personal care? *

Does your child have other friends who have applied to this camp? *

CARE NEEDS

Please provide specific details about your child’s disability *

Please provide specific details about your child’s behaviour support needs *

Does your child require any regular physiotherapy or exercise regimes? *

Does your child have any mobility needs? Please include any aids required (wheelchair, frame, scooter etc) *

Please advise if there are any safety risks that we should be aware of with your child (e.g., prone to running away) *

Please advise if there are particular environments in which your child may become distressed? (E.g., loud/ crowded/ claustrophobic/ around water) *

Please provide details on your child’s daily living skills and highlight key areas where your child may need extra support? *

Does your child feed themselves? Are there choking concerns? *

Please provide any care plans which relate to any of the above *

List of Allowed file types

PERSONAL NEEDS

Does your child have any religious/ spiritual needs? If so, please explain requirements? *

Does your child have any specific language and/ or communication needs? *

Is your child from an Aboriginal or Torres Strait Islander background? *

OTHER NEEDS

Does your child require help when toileting or wear nappies? *

Has your child spent a night away from home before? *

What time does your go to sleep and wake up (generally)? *

Does child wake during the night? *

What support techniques could be used should your child display difficult behaviour? *

Please select your child’s swimming ability (tick all that apply) *

Very competent in deep water
Swims unaided
Requires flotation device
Requires more than one assistant for support in the water
Does not like swimming

How often does your child swim? *

Does your child require pullups or continence protection during swimming? *

MEDICAL

Does your child require regular medication? Please provide information

Medication Name	Dosage	Time administered

Is your child compliant when taking medication? *

Does your child have any food allergies? Please provide information: *

Does your child have other allergies? Please provide information: *

Does your child require a special/ specific diet and or particular feeding technique? Please provide information: *

Does your child suffer from anaphylaxis? *

Yes

Does your child require an epipen? If Yes, please upload an ASCIA plan below. You are required to provide 2 epipens for the camp. *

Yes

If your child requires an epipen please upload the ASCIA plan here

List of Allowed file types

Does your child have any of these common allergies or sensitivities? *

Food colourings
Food stuffs/gluten/G6PD/broad or fava beans/eggs/fish/seafood
Animal hair
Grasses/pollens
None of the above

Any allergy not mentioned above?

What is your child's reaction to any of these allergies or sensivities?

Does your child suffer from asthma? *

Yes

Does your child suffer from diabetes? *

Yes

Does your child suffer from epilepsy/fits? *

Yes

Does your child have other medical conditions/ issues or requirements? *

Is your child vaccinated against flu? *

Yes

Is your child vaccinated against COVID? *

Yes

Please provide any care plans which relate to any of the above

List of Allowed file types

Please describe methods you use to help your child manage in situations of difficult behaviour at home *

Please describe methods you use to help your child manage in situations of difficult behaviour at school *

Please describe methods you use to help your child manage in situations of difficult behaviour on outings *

Is your child on a behaviour management plan? *

Yes

if yes please attach a copy to this application

List of Allowed file types

ADDITIONAL INFORMATION

Could you please record a short video of yourself with your child discussing the following three questions. You might like to use any non-verbal communication aides. If this is not possible, you can type a response to these questions, but we would love if you can include your child's perspective.

1. Why would you like to attend Sony Camp?

2. What would you most look forward to doing on Sony Camp?

3. Is there anything about Sony Camp that you do not think you will like?

4. Would you like to tell us anything else about yourself or about applying for Sony Camp?

Please upload your video here: https://knoxgrammar.com/ABBOX23

CONTACT INFORMATION

Parent/ Guardian Name/s *

Parent/ Guardian residential address *

Child’s residential address (if different to above)

Parent/ Guardian Contact Number/s *

Parent/ Guardian email address *

EMERGENCY CONTACTS

Please provide two emergency contacts (name and telephone number) for your child.

It is imperative that these people will be contactable for the duration of camp and are in Australia.

Emergency Contact 1 *

Emergency Contact 2 *

OTHER INFORMATION

Please provide the name and contact details of your child’s current school *

Please provide the name and contact details of your current family GP *

Please provide the name and contact details of any additional formal supports/ carers for your child *

Please provide the name and contact details of any additional informal supports/ carers for your child *

CONSENT

Media Consent: Do you agree for your child to be photographed/ videoed on Sony Camp and understand that content may be used to promote Sony Camp by the school or Sony Foundation in future? *

Yes

GP Consent: Do you agree to a Sony Camp committee member or Sony Camp doctor/nurse to contacting your GP regarding your child and their needs/ medical requirements? *

Yes

School: Do you agree to a Sony Camp committee member or Sony Camp doctor/nurse contacting your child’s school to collect additional information (when required in the best interest of the child)? *

Do you give permission for photos to be taken of your child? *

Yes

Do you give permission for photos to be used for advertising purposes? *

Yes

DECISION MAKING & COMPLAINTS

Decision making, I understand that I have/ my child has the right to make specific choices/ decision about their on Sony Camp experience/ activities undertaken etc., and will discuss this with the Sony Camp coordinator if required *

Yes

I understand that I am entitled to access the complaints policy for this camp. I understand that I have/ my child has the right to make a complaint about Sony Camp, and will discuss this with the Sony Camp coordinator or committee member if required *

Yes

Acceptance *

I agree that the information I have provided is correct

I agree for information about my child to be shared should it be in their best interest to do so i.e. a medical emergency

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