Welcome to the Summer of 2020!

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Registration and Waiver Form

Preferred Camp (s) *

Day Camp (ages 4 - 12)

LIT - Leaders in Training (ages 12 - 16) - Day Camp only

Required

Camper's Name *

Camper's Age on the first day of camp - must be 4 yrs old *

Camper's Gender *

Boy

Girl

Other:

Parent's Name (s) *

Primary Phone Number *

E-mail Address *

Transportation *

Own Transportation - Regular Times (8:30am - 3:30pm)

Required

Anaphylactic Allergies *

Does your child carry an epi-pen or have a serious medical allergy?

yes

Dietary Requirements *

I acknowledge that due to health and safety guidelines, all campers will bring their own drinks, snacks & food

Required

Medical History *

Please describe any relevant information in regards to your child's physical health - or answer n/a for non-applicable.

Emotional, Social and Mental Health History *

Please describe any information that might be helpful regarding anxiety, depression, ADHD, OCD, ASD, Aspergers, OCD and any other relevant information - or answer n/a for non-applicable.

Does your child have 1:1 support at school *

Yes

Any Other Important Information? *

Is there any additional information about your child that you wish to share. For example: difficult home/school situations, bullying, care of braces/contacts, shyness, home sickness, special procedures that are to be used at the camp. Please be as thorough as you can. It is the parents’/guardians’ responsibility to inform the camp of any emotional, physical, physiological, social or medical challenges faced by the camper that may have an impact upon their camp experience. If you feel that any of these items require further discussion with the camp, please contact the Directors at any time. If you do not have anything to report, please answer n/a for non-applicable

Day Camp Preferred Session(s) - including LITs *

Session 1 (July 13 - 17)

Session 2 (July 20 - 24)

Session 3 (July 27 - 31)

Session 4 (Aug 4 - 7) * Short week

Session 5 (Aug 10 - 14)

Session 6 (Aug 17 - 21)

Session 7 (Aug 24 - 28)

Session 8 (Aug 31 - Sept 4)

Required

Explorers Camp(s) - Preferred Session(s)

Not available this summer

Voyageur Camp(s) Preferred Session(s)

Not available this summer

Canoe Trippers Camp(s) Preferred Session(s)

Not available this summer

Junior Guides = Canoe trip # 1 (Session 1 - June 28 to July 3) Canoe trip # 2 - please select 3 weeks that you would prefer

Not available this summer

Emergency Contact & Phone Number *

Family Doctors Name & Phone Number *

Do you give us permission to contact the Doctor if necessary? *

Yes

Other:

Do you give us permission to administer age appropriate over-the-counter medication? *

Yes

Has you child ever been stung by a bee or a wasp? *

Yes - it was a normal reaction

Yes - please administer some Children's Benadryl to help with swelling & pain

No - as a precaution, please administer some Children's Benadryl to help with swelling & pain

No - please monitor, but do not administer Children's Benadryl

Health Card # *

Is your child's immunization record up to date *

Yes

Can your child independently swim without the aid of a flotation device? *

Yes

No - please ensure that they wear a pfd

Maybe

Do you agree to the following Booking Conditions: Full payment ($275 no HST, per week) must be paid at time of booking to confirm your space. However, until we receive confirmation from the Ontario government - we are only accepting registrations and no payment is required. We will let you know as soon as we know more. *

Yes

I have received funding

Please provide information regarding who is allowed to pick-up your child from camp or from the camp transportation shuttle. *

Would you like to subscribe to our e-newsletter for up-coming events and information? *

Yes

I am already subscribed

Required

Do you agree to the Participation Waiver and Medical Consent information listed below? *

Great Moose Adventures reserves the right to suspend clients from activities, programs or performances where their behaviour is deemed unacceptable.Great Moose Adventures cannot be held responsible for the loss, theft or damage of belongings.Great Moose Adventures reserves the right to use photographs/video material of the clients and material created for promotional purposes such as web site, brochures and displays. All films, projects, music, songs, artwork etc. created at Great Moose Adventures may be used by Great Moose Adventures for promotional or educational purposes.By agreeing to these Terms & Conditions the parent or guardian of a child attending a Great Moose Adventures day program fully understands that such a program involves outdoor and indoor physical activities during variable weather conditions and that there are health and safety risks associated with these types of activities.By agreeing to these Terms & Conditions the parent or guardian, their heirs and assigns waive, release and absolve and agree to indemnify and save harmless Great Moose Adventures and their respective directors, officers, employees and agents from all liability arising from attendance and participation in a Great Moose Adventures day program.By agreeing to these Terms & Conditions the parent or guardian affirms that they fully understand the preceding paragraphs and volunteer their child to participate at their own risk.

Yes

Payment Option *

E-transfer to directors@greatmooseadventures.com - we will send you an email with your total amount due

Cheque - 1368 Housey's Rapids Road, Gravenhurst, ON, P1P1R3

Credit Card - a 2.9 % administration fee will be added to the cost - we will send you an email with a link for a credit card payment

Special Funding - we will contact you to verify

Submit

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