Grade 4-6 Week Long 2023
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Camper Name (First and Last) *
Date of Birth *
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What Grade Will Your Child Be Entering in 2023? *
Gender *
T-Shirt Size *
If you and a friend would like to be assigned to the same cabin, we will do our best to accommodate. Name of friend (one only)
Does the Camper attend church?
Clear selection
If Yes, Church Name and Name of Minister/Pastor?
Parent/Guardian Name *
Phone Number *
Email Address *
Street Address *
Is there a joint custody arrangement? *
Emergency Contact Name *
Emergency Contact Phone Number *
Secondary Emergency Contact
Secondary Emergency Contact Phone Number
Provincial Health Card/Insurance Number *
Does the Camper have any allergies/dietary restrictions? *
List any allergies/dietary restrictions
Please list any physical conditions which may hinder full participation in camp programming
Please list any medications that the camper may be taking at time of camp including instructions on dosage/ administration
Please indicate which vaccinations your camper has *
Required
Please indicate which of the following medications your child is permitted to have should the child get a headache, allergic reaction or stomach ache. If you do not select the medication, these medications will not be administered to your child.
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Required
Note: All medication that is to be dispensed during a campers stay at Canoe Cove Christian Camp must be handed in to the Nurse/Medical personnel or to a designated adult during sign-in, and will be administered to the applicant camper per instructions. All medications will be locked up and given at the appropriate times for each day at the Medical Station. Each camper is required to have the medications in their original packaging or in a blister pack (talk to your pharmacist or doctor about these packs).

Medical Waiver: This waiver gives authority to Canoe Cove Christian Camp, Inc., or to a designated adult, to arrange for Medical / First Aid care for a minor in the event of an emergency while attending Canoe Cove Christian Camp.
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I hereby approve and confirm his or her participation, and release Canoe Cove Christian Camp Inc., its Directors, the management, staff, agents, employees, or any persons associated with Canoe Cove Christian Camp Inc., from any claim or action for any injury or injuries that may be received by the said child while attending Canoe Cove Christian Camp, and/or any normal camp activities associated with Canoe Cove Christian Camp including those off of the property of Canoe Cove Christian Camp.
I agree to permit the reasonable use of photos and videos or other pictures of applicant camper in promoting the camp or camp activities or programs.
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How will you be paying? Please note that registration is not confirmed until the camp received the pre-registration fee of $50 (Or complete Camp Payment). Note: The $50 registration fee is non refundable after June 1st 2023
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