Summer Camp Registration

 

 

 

Limited spots available. Register by June 23, 2017

Number of Campers:*
Camper Name:*

Gender:*
Date of Birth:*
 / 
 / 
Select Grade:*
Camper Name:(2)*

Gender:(2)*
Date of Birth:(2)*
 / 
 / 
Select Grade:(2)*
Camper Name:(3)*

Gender:(3)*
Date of Birth:(3)*
 / 
 / 
Select Grade:(3)*
OHIP Health Card:*

Allergy:

Medical History:
OHIP Health Card:(2)*

Allergy:(2)

Medical History:(2)
OHIP Health Card:(3)*

Allergy:(3)

Medical History:(3)
Parental/Guardian Name:*

E-mail:*
Home Phone:

-

Cell Phone:*

-

Emergency Contact:*

Cell Phone:(1)*

-

Home Phone:(1)

-

I understand that caution will be taken by the persons in charge to prevent injury, but neither those in charge nor the church will be held responsible in case of an accident. In the event of an emergency, I give permission to attain medical treatment if required and I further authorize the release of the above medical information to the appropriate medical personnel. I give permission for my child to be fully involved in the program and understand that my child may be sent home in the event that he/she does not abide by the rules of the camp.


This information is confidential. It enables the instructors and guides to reduce the risk of injury or illness complications, as well as to prepare emergency plans in the event that an emergency does occur.

I have honestly disclosed all of the information requested in the questions; and I understand that withholding information may contribute to injury or illness complications, and possibly compromise the care provided in the event of an emergency. If any of the above information changes prior to, or during the program, I will immediately notify the leader.

Consent:*

Word Verification: