Booking Form

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Account Details
Parent/Carer
First Last
Home Address*
House Number and Street Name Town/City County PostCode
Email*
Permission to Contact You Via Email*
- Yes, you have my consent
- No, I do not provide my consent
MSA Camp will ONLY contact you via email about camps which your child is attending. It is our policy not to share any personally-identifying material obtained through MSA Camp's website with any third party.
Contact Number*
Username*
Password
Enter Password Confirm Password

CAMPER DETAILS
Camper 1's Name*
First Last
Camper 1's Date of Birth*
Does Camper 1 have any medical conditions/allergies?*
Camper 1 Medical/Allergy Information*
Please can you provide information on your child’s condition. If medication needs to be provided please can you name the medication, the dosage, and frequency of administration, whether you want the medication or medical devices to be self-administered with supervision or staff to administer.
Emergency Contact's Address*
House Number and Street Name Town/City County PostCode
Emergency Contact Number*
GP Surgery Name*
GP Surgery Street Name Town/City County PostCode
GP Phone Number*
Camper 1's School*
Name of Camper 1 School (not listed)
Camper 2
Camper 2's Name
First Last
Camper 2's Date of Birth
Does Camper 2 have any medical conditions/allergies?*
Camper 2 Med info
Please can you provide information on your child’s condition. If medication needs to be provided please can you name the medication, the dosage, and frequency of administration, whether you want the medication or medical devices to be self-administered with supervision or staff to administer.
Home Address*
House Number and Street Name Town/City County PostCode
Emergency Contact Number*
GP Surgery Name*
GP Surgery Street Name Town/City County PostCode
GP Phone Number*
Camper 2's School*
Name of Camper 2 School (not listed)
Camper 3
Camper 3's Name
First Last
Camper 3's Date of Birth
Does Camper 3 have any medical conditions/allergies?*
Camper 3 Medical/Allergy Information
Please can you provide information on your child’s condition. If medication needs to be provided please can you name the medication, the dosage, and frequency of administration, whether you want the medication or medical devices to be self-administered with supervision or staff to administer.
Home Address*
House Number and Street Name Town/City County PostCode
Emergency Contact Number*
GP Surgery Name*
GP Surgery Street Name Town/City County PostCode
GP Phone Number*
Camper 3's School*
Name of Camper 3 School (not listed)
Camper 4
Camper 4's Name
First Last
Camper 4's Date of Birth
Does Camper 4 have any medical conditions/allergies?*
Camper 4 Medical/Allergy Information
Please can you provide information on your child’s condition. If medication needs to be provided please can you name the medication, the dosage, and frequency of administration, whether you want the medication or medical devices to be self-administered with supervision or staff to administer.
Home Address*
House Number and Street Name Town/City County PostCode
Emergency Contact Number*
GP Surgery Name*
GP Surgery Street Name Town/City County PostCode
GP Phone Number*
Camper 4's School*
Name of Camper 4 School (not listed)

Swimming Approval
- Swim Fin
- No Fin (shallow)
- No Fin (deep)
Do you give consent for your child/children to participate in video/photographs taken during the camps?*
- Yes
- No
We use these images on our website and social media pages to both promote our camps and provide memories to parents and campers of their experience with us.
ADDITIONAL SECURITY
We ask you provide a secret codeword, that way nobody can pick up your child/children unless they know this codeword.
Choose a 'Secret' codeword*

Payment Details
Our website is secure for credit card payments and your card information will not be stored on our website
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- Debit/Credit Card
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Booking Form

Existing Users Login HERE

Step 1 of 5

Account Details

BOOKING DETAILS

BOOKING DETAILS

BOOKING DETAILS

CAMPER DETAILS

Camper 2

Camper 3

Camper 4

Payment Details

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