Microsoft word - camperapplication.doc

We are so glad that you have chosen to accept our invitation to allow your child to attend Echo Lake Bible Camp this summer. Campers are sure to have a great time making new friends, learning about God, and enjoying all the wonderful activities we have planned! Once you have completed the registration form and attached your registration fee, please mail to the following address: ECHO LAKE BIBLE CAMP
c/o Donald & Jane Peck
P.O. Box 54
Lipton, SK S0G 3B0
Questions regarding JR Camp can be directed to this year's Co-Directors, Donald or Jane Peck at office@liptonemc.org or (306) 336-2210. Hey, Kids! Do you know someone who has never been to camp, but who might like to come? Why not invite them? We've included two of our special party invitations in this mailing—one for you to keep and one to give away. Who could you invite?
Last Name: ___________________________ First Name: _____________________
Address: ______________________________________________________________
City, Province: _____________________________ Postal Code: _______________
Home Phone: ( ) _______________ Email: ______________________________
Sex: M F Birth Date: _______________________ Age: _________
(Day/Month/Year)

Grade (as of September 2007): Gr. 1 Gr. 2 Gr. 3 Gr. 4 Gr. 5 Gr. 6 Gr. 7
Home Church (if applicable): _______________________________________________

Emergency Contact Information
Parent/Guardian 1: _____________________________________________________
Phone: _______________ Work Phone: ________________ Cell: ______________
Parent/Guardian 2: _____________________________________________________
Phone: _______________ Work Phone: ________________ Cell: ______________
Alternate Contact: ______________________________________________________
Phone: _______________ Work Phone: ________________ Cell: ______________

Camp Information

Are you interested in…

Requesting a cabin mate? (Both campers must request each other and be of the same age.) Name of cabin mate (only 1 please): ________________________
Daily canteen and camp T-Shirts are included in the cost of registration. Do not send money with your child to camp. Please select T-shirt size:
Child:


Medical Information
List any known allergies or other health conditions (i.e., allergies to animals, epilepsy):
______________________________________________________________________
______________________________________________________________________
List any special or restricted dietary needs:
______________________________________________________________________
______________________________________________________________________
List any medications currently being taken (all prescription medication must be sent in
the original bottle):
______________________________________________________________________
______________________________________________________________________
Please indicate which medications may be given to your child as needed:
Cough syrup Ibuprofen (Motrin, Advil) Tums Benadryl Decongestants Acetaminophen (Tylenol) Pepto Bismol Gravol Antihistamines Please indicate which of the following your child has experienced: Headaches Indigestion Bed wetting Depression Cramps Vision problems (glasses/contacts) ADD/ADHD Other: _________________________ Additional Health Notes: __________________________________________________ ______________________________________________________________________ ______________________________________________________________________
Medical Contact Information

Family Physician: ____________________________ Phone: ( ) ______________
Health Care #: _______________________________ Province: _____________

Date of last Tetanus shot/booster: _____________________________
(mm/dd/yy)
I declare that this medical information is correct to the best of my knowledge. I hereby give
permission to the medical personnel selected by the camp to provide my child with medical
treatment in case of an emergency.


__________________________________

Payment Information

Early Bird (must be post-marked by May 31st)
Regular Registration Fee
Registration fee includes the cost of a T-shirt and daily canteen. Registration deadline for JR Camp is June 27th. No registrations will be
Please make all cheques payable to 'Echo Lake Bible Camp.' Please, no


General Information
Upon receiving your registration, we will send you a confirmation package containing information about what to pack, arrival times, closing program, and important reminders. Daily canteen and a T-shirt are included in the cost of registration. Please ensure that you have specified your child's T-shirt size on the registration form. Please do not send money or other valuables with your child to camp (i.e., MP3s or cell phones, etc.).
Waivers & Conditions
1. The Co-Directors reserve the right to dismiss a camper who, in their opinion, presents a
hazard to the safety and rights of others, or who appears to have rejected the reasonable
controls of the camp. If this occurs, the fee is non-refundable.
2. The parent/guardian submitting the application is the person having legal custody over the
child. Conditions of custody, if applicable, will be fully communicated in writing to the camp.
3. All prescribed medication must be in the Original Prescription bottle (please send sufficient
supply with a few extra). All medications will be administered by the camp nurse.
4. I herewith give consent for the camp administration to secure medical treatment in the event
of an emergency. I give permission for the medical staff to administer medication.
5. The signature of the parent or guardian on this application gives permission to Echo Lake
Bible Camp to transport the camper off-site should he/she require medical attention. Should this
occur, the camp will attempt to notify the parent/guardian or alternate as soon as possible. The
parent/guardian is responsible for any additional medical expense that may be incurred (i.e.,
medications).
6. The signature of the parent/guardian on this application shall give Echo Lake Bible Camp the
right to use pictures or videos of your child for promotional purposes.
(If no, please include a recent photo of your child so that we may be able to readily identify your child in photos/videos and ensure that they are not included in such material.)
With my signature, I affirm that the information given is complete and accurate. I have carefully
read all the registration information and agree to abide by the Waiver and Conditions of
Enrolment.
__________________________________________
__________________________

Source: http://www.echolakebiblecamp.ca/jrcamp2007/jrcamp2007information/CamperApplication.pdf