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Online Registration (Summer Camp 2008)

Family Email:

CAMPER INFORMATION
First Name:
Last Name:
Gender:
Birthdate:

FAMILY INFORMATION
Address:
City:
Province:  Postal Code:
Country: Other
Phone: () -
Fax: () -
Home Church (if applicable):
Mother's Name:
Mother's Home Phone: () -
Mother's Work Phone: () -
Father's Name:
Father's Home Phone: () -
Father's Work Phone: () -
Family Cell Phone: () -
Doctor's Name:
Doctor's Phone: () -
CareCard/ Insurance #:


EMERGENCY CONTACT PERSON (should we not be able to get ahold of the numbers listed above)
Name:
Relationship to Camper:
Home Phone: () -
Alternative Number: () -
Legal Custody:
If other, please specify:


Additional Information
Is the child a first time camper?
How did you hear about us?
Name of preferred Cabin Partner 1:
Name of preferred Cabin Partner 2:
T-shirt size


Medical Information

Please note, you will be required to fill in a more detailed medical form closer to camp to ensure we have the most up-to-date information.
Please list any allergies or diet restrictions(medical):


Camp Choice:
Select camp
**IFCC #2 is processed by application. Applications must be approved before registration is complete for this session only. Please click here for an application.


PAYMENT INFORMATION:
Payment method: Cheque*  Visa  American Express  Mastercard
Card Number: - - -
Expiry Date: /
Name on Card:
Amount to charge:
* If paying by cheque please remember that a registration is not secured until we have received payment and a signed health form.
Box must be checked to submit the form

I understand that by submitting this form I am in agreement with the following terms and conditions as listed below and certify that I am the parent or guardian of the child as listed above:

I understand that every effort will be made to contact me in case of a medical emergency. I hereby consent to having my child named on this form treated at a recognized hospital or local physician. I consent to over the counter medications, if necessary (eg. Tylenol), as approved by the Camp Nurse on site or by a local physician. To the best of my knowledge I have informed Camp Columbia of all details about this child's health and will contact camp regarding any changes before camp. I will COMPLETE THE HEALTH FORM and bring the form and medications with my child on registration day. I recognize that Camp Columbia will do its best to ensure a safe experience. I hereby release Camp Columbia, staff, the camp nurse, and all volunteers from any reponsibility and liability of any nature resulting from my child/self/ward's participation in any activity.
I agree to allow my child to be used in future Camp Columbia publications only.
Any additional comments or questions:

Please note you will receive a confirmation package by mail including a health form that will need to be signed and returned to camp at least 2-weeks prior to the start date. Should you have listed any questions our staff will contact you as soon as possible via email.

We look forward to welcoming your child in Summer 2007!


     

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