Jabiru Student Application 2022

CAMP JABIRU 2022 STUDENT APPLICATION

Important Dates:

Camp Orientation - 9th April 2022

Camp Jabiru - 10th-14th April 2022

Important Announcement: All student positions have been filled for Camp Jabiru 2022. We appreciate your interest in camp. You are still welcome to submit an application and be placed on a waitlist for a spot should one become available. DO NOT make a payment with your application. Payment will be taken if/when you are offered a spot.

First Name *

Last Name *

Street Address *

Address Line 2

City *

State/Province/Region *

Zip/Postal Code *

Phone Number *

Email Address *

School Attending *

Year in school in 2022 *

Briefly explain your interest in working as an OT in paediatrics: *

Briefly explain what you hope to get out of the Camp Jabiru experience: *

Please list any special interests and/or skills you might be able to contribute at camp (i.e. music, sign language, leadership, creativity, etc.): *

Which age range would you be most interested in working with? *

4-8 years old (Day campers)

8-12 years old (Overnight campers)

8 years old (Transition campers: day campers/overnight one night)

12+ years old (Jabiru 2.0--Overnight campers/apprentice program)

No preference

Please provide your Working With Children Check number. (Please note you are also required to upload a copy of your WWCC with this application.) *

T-shirt Size *

Please list any special dietary needs (note there is an additional $25 fee for gluten-free meal provision during camp) : *

Please list any allergies (i.e. foods, drugs, insects, plants): *

Please list any health issues you suffer from including chronic injury, illness, and/or emotional disorders (i.e. asthma, chronic fatigue syndrome, depression, etc). *

Please list anything that would restrict your participation in activities at camp (i.e. back injury, fear of heights, etc.). *

How would you rate your swimming ability? *

Unable (Nothing more than dog paddle)

Poor (Basic strokes, only limited strokes beyond domestic swimming pool)

Good (Strong swimmer, able to swim confidently in a variety of water conditions)

Excellent (Very strong and confident, could swim 50 mtrs fully clothed)

Is there anything else we need to know? *

Would you like to stay overnight at camp on the 8th April 2022 (note there is an additional $55 fee for staying overnight on this date)? *

Yes

Check here to confirm you have read the student expectations (found on The Sensory Gym® website) for participation at camp: *

Yes, I have read the student expectations document.

No, I have not read the student expectations document.

Please attach a copy of your current working with children check. *

Please attach a recent photo of yourself. *

Please attach your completed YMCA medical form. *

Please note: Applications will be taken until positions are full. The amount of $200 is payable with your application. Please include $25 if you are requesting a gluten free diet and $55 if you want to stay at camp on the night of the 8th April 2022. All payments will be refunded immediately if a place is not made available to you. Payment methods include direct deposit or credit card (please note that a 1.155% surcharge will be applied to credit card payments). Your $200 fee includes meals and lodging at camp (arriving 9th April 2022 and departing 14th April 2022).

I will pay by *

Direct Deposit

Credit Card

To pay by credit card, please provide the following information:

Name on Credit Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

CVV Number *

To pay by direct deposit please remit full payment to:

Acct Name: The Sensory Gym Pty Ltd

Bank: St. George

Branch: Richmond

BSB: 112 879

Acct No: 491 763 765

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