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Family Application Form

Introduction

If you have a child 0-13 years old and have cancer in your household you can apply to join Camp Quality today.

If you don't want to complete a form online, you can phone our Family Support Team on 1300 665 605.

Parent/Guardian 1 - Primary Contact

Relationship to child(*)
Please let us know your relationship with the child.

First Name(*)
Please let us know your first name.

Last Name(*)
Please let us know your last name.

Address(*)
Please let us know your address.

Suburb(*)
Please let us know the suburb of your address.

State(*)
Please let us know the state of your address.

Postcode(*)
Please let us know the post code of your address.

Mobile(*)
Invalid Input

Home Phone
Please let us know your home phone number.

Email(*)
Invalid Input

T-Shirt Size
Invalid Input

This Person Has Cancer
Invalid Input

Parent/Guardian 2

Relationship to child(*)
Please let us know the 2nd parent/guardian's relationship with the child.

First Name(*)
Please let us know the 2nd parent/guardian's first name.

Last Name(*)
Please let us know the 2nd parent/guardian's last name.

The Address Is The Sames As The Primary Contact
Invalid Input

Address
Please let us know the 2nd parent/guardian's address.

Suburb
Please let us know the 2nd parent/guardian's address' suburb.

State
Please let us know the 2nd parent/guardian's address' state.

Postcode
Please let us know the 2nd parent/guardian's address' post code.

Mobile
Invalid Input

Home Phone
Please let us know the 2nd parent/guardian's home phone number.

Email
Invalid Input

T-Shirt Size
Invalid Input

This Person Has Cancer
Invalid Input

 

Family Information

Reason For Joining(*)
Please fill in your reason for joining.

Due to the high demand on our services, Camp Quality is only able to accept families who have experienced bereavement in the last 24 months.
How did you hear about Camp Quality?
Invalid Input

Diagnosis Date(*)
Invalid Input

Diagnosis(*)
Invalid Input

Other Diagnosis Information
Invalid Input

Hospital
Invalid Input

Other Hospital
Invalid Input

Social Worker
Invalid Input

Your Closest Camp Quality Office(*)
Please let us know your closest Camp Quality office.

What languages other than English are spoken at home?
Invalid Input

Other Language
Invalid Input

Do you identify as Aboriginal or Torres Strait Islander heritage?
Invalid Input

 

Children

Child 1

First Name(*)
Invalid Input

Last Name(*)
Invalid Input

Date of Birth(*)
//Invalid Input

Gender(*)
Invalid Input

School Name and suburb(*)
Invalid Input

T-Shirt Size
Invalid Input

This Child Has Cancer
Invalid Input

Would you like to enter another child?
Invalid Input

Child 2

First Name
Invalid Input

Last Name
Invalid Input

Date of Birth
//Invalid Input

Gender
Invalid Input

School Name And Suburb
Invalid Input

T-Shirt Size
Invalid Input

This Child Has Cancer
Invalid Input

Would you like to enter another child?
Invalid Input

Child 3

First Name
Invalid Input

Last Name
Invalid Input

Date of Birth
//Invalid Input

Gender
Invalid Input

School Name and suburb
Invalid Input

T-Shirt Size
Invalid Input

This Child Has Cancer
Invalid Input

Would you like to enter another child?
Invalid Input

Child 4

First Name
Invalid Input

Last Name
Invalid Input

Date of Birth
//Invalid Input

Gender
Invalid Input

School Name and Suburb
Invalid Input

T-Shirt Size
Invalid Input

This Child Has Cancer
Invalid Input

I have more children
Invalid Input

We will contact you to get the details of the remaining children in your family.

Privacy Notice

Camp Quality Limited collects the personal information of participants and their families, including sensitive information such as health information, in order to administer our programs, including complying with our legal obligations and where you give permission, obtaining photographs or interviews for use in marketing material. We also collect some information from third parties such as doctors to ensure that individuals who participate in our programs receive the correct medical treatment.

We may also collect personal information in order to communicate with families and their participants about our initiatives.

Our Privacy Policy contains information about: (i) how you can access and correct your personal information; and (ii) how to lodge a complaint regarding a breach of the Australian Privacy Principles or the handling of your personal information and how such a complaint will be handled by Camp Quality. You may contact our privacy officer with any queries via email on privacy officer@campquality.org.au or via mail on Camp Quality Limited, PO Box 400, Epping NSW 1710 or via telephone on 02 9876 0500.

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