YPO Camp 26 – 27 March 2022 YPO CAMP | 26 - 27 March 2022 Details of Child AttendingChild's Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date of Birth(Required) Day Month Year Age (at time of camp)Lives with: Both parents Mother only Father only Shared time between Mother and Father Other Does your child have dietary requirements?(Required) Yes No If so, please provide details:Does your child have any medical conditions?(Required) Yes No If so, please provide details. Include medication currently taken and the dosage. If the medical condition is asthma or allergy related, please include any known triggers (plant pollen, insect bites etc), describe signs and symptoms of a reaction (wheezing, coughing, tightness in chest, difficulty breathing etc). Please also provide detailed instructions on what to do at the first sign of a reaction and treatment required after a reaction. We ask that you please ensure that appropriate medication is brought to camp and carried at all times. Thank you.Is there anything else we need to know about your child?Emergency ContactPerson to be contacted in an emergency (must be someone who is not attending the camp) First Last Mobile Number - Emergency Contact(Required)Attending Parent's Detailsor accompanying mentorParent Attending's Name(Required) First Last Parent Attending's Phone(Required)Parent Attending's Email(Required) Relationship of the child Mother Father Other Other Does the parent attending have dietary requirements?(Required) Yes No If so, please provide details:Does the parent attending have any medical conditions we should be aware of?(Required) Yes No If so, please provide details. Include medication currently taken and the dosage. If the medical condition is asthma or allergy related, please include any known triggers (plant pollen, insect bites etc), describe signs and symptoms of a reaction (wheezing, coughing, tightness in chest, difficulty breathing etc). Please also provide detailed instructions on what to do at the first sign of a reaction and treatment required after a reaction. We ask that you please ensure that appropriate medication is brought to camp and carried at all times. Thank you.Any medical conditions that would make it difficult to walk up to 3 kms across moderate terrain? Yes No Please specifyEmail (the camp information will be sent to this email on registration)(Required) Opt in I consent to receiving marketing communications from The Rites of Passage Institute.
