Canyon Church Camp
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Youth Registration Form
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Indicates required field
First Name
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Last Name
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Birthday (dd/mm/yyyy)
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Age On Camp Start Date
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Gender
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Male
Female
Address
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City
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Province
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Postal Code
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Email
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Camp(s) Registering For:
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Junior 1 (Ages 6-9) July 4-7 - FULL. WE ARE NO LONGER ACCEPTING REGISTRATIONS FOR THIS CAMP.
Junior 2 (Ages 8-10) July 9-14
Junior 3 (Ages 10-12) July 16-21
Junior 4 (Ages 11-14) July 30 - August 4
Intermediate 1 (Ages 13-15) August 6-11
Senior Teen (Ages 15-17) August 13-18
T-Shirt Size
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Child - Small
Child - Medium
Child - Large
Adult - Small
Adult - Medium
Adult - Large
Adult - X-Large
Do you have a friend that you would like to share a cabin with? If yes, please give us their name, and we will do our best to accommodate your request (only ONE request per camper).
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Contact Information
Parent/Guardian Name
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Parent/Guardian Cellular Number
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Parent/Guardian Home Number
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Parent/Guardian Work Number
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Emergency Contact Name
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Emergency Contact Relationship to Camper
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Emergency Cellular Number
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Emergency Home Number
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Emergency Work Number
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If you are unable to pick-up your child on the last day of camp, please provide:
Alternate Pick-up Name
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Alternate Pick-up Relationship to Camper
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Alternate Pick-up Cellular Number
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Alternate Pick-up Home Number
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Alternate Pick-up Work Number
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Camper Medical Information
Tell Us About Your Child
: It is with sincere interest we would like to obtain as much information about your child as possible, so that our staff can provide the absolute best experience of attending camp.
All information is kept confidential
, and is only used to provide Heath Care and to help our Directors to ensure a safe, comfortable, and fun time for all our campers. If you prefer to speak directly with our Camp Medic or Directors, please feel free to do so at the time of drop off, or contact the registrar, and she will direct you to them through email or phone number. The more information our Medic and Directors have, the more we can do to ensure your child enjoy themselves.
Medications and Allergies
:
Must
be given to Camp Medic on arrival. Medications must be labeled with the name of the medication and dosage regimen. A separate form will be completed at time of drop off listing medications and instructions, in case of any possible allergic reactions at Camp.
CCC strives to be a
Peanut Free Facility
, and do not intentionally have peanuts at camp.
Health Care Number
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Name of Family Doctor
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Phone Number
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Dietary Restrictions
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Yes
No
If yes, please explain in detail what restrictions.
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Health Concerns
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Asthma
Bed-wetting
Behavioural Concerns
Bowel Incontinence
Diabeties
Learning Disability
Seizures
No Concerns
Other
Are your immunizations up-to-date?
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Yes
No
If other, please explain your health concerns.
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Will your child be restricted from any activities at camp?
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Yes
No
Ability to swim 25 metres?
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Yes
No
If yes, please explain your restrictions.
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Level of Swimming Lessons
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Canyon Church Camp Authorization and Consent
Dependent Registration:
The child named herein has permission to engage in all prescribed camp activities, except as noted above, and I agree that he/she will be subject to the rules and regulations of Canyon Church Camp. In the event I cannot be reached in a Medical Emergency, I hereby give permission that medical treatment will be obtained. I agree to pay any charges not covered by my Medical Plan, ie. medications, ambulance, etc. I hereby waive all claims against the Canyon Church Camp Association, and is representatives, for any accident or injury that may occur to the child named above in connection with the events for which application to attend has been made.
I consent that images may be used for camp promotion unless written objection is provided to the Registrar.
I have read the above "Canyon Church Camp Authorization and Consent," and agree to abide by all rules and regulations as outlined. I fully understand that submitting this form will be accepted as my legal signature on the form.
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Yes
Name
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Relationship to Camper
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Date
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Comment
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To ensure payment has been received, please specify the email address you will be using for Pay Pal.
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Please note: Placement of camp cannot be confirmed until payment is recieved.
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