Summer Camp Registration 2024

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Please complete the form below with all required information. You will receive a confirmation email when you have completed the form and will be contacted through the email provided by camp staff to confirm your registration. If you do not hear from us within 3 working days, please email: b.toogood.segrave@gmail.com
Please complete 1 from per camper.

Email *

Camper First/Last Name *

Camper's Age (as of August 19th, 2024) *

Camper's Address (Street, City/Town, Postal Code) *

Parent/Guardian First/Last Name *

Parent/Guardian Cell Phone *

Parent/Guardian Email *

Emergency Contact First/Last Name *

Emergency Contact Cell Phone *

Please list all of the people's names (first/last) who are permitted to pick up your child from camp. Please include any names listed above as well. *

Camper's OHIP Card Number *

Are there any medical conditions that require any medications to be self-administered at camp?

Is there anything we should know to help make your child's time at camp a positive experience?

Please list below any medical conditions we should be aware of. Please list their treatments and if EMS should be called. (ie. asthma, epilepsy)

Please list below any food allergies we should be aware of.

Does your child carry an epipen? *

Yes

Does your child know how to administer their own epipen? *

Not applicable

Yes

Please list any dietary restrictions below.

Consent

For each option below, please print your initials to indicate your consent to the following statements.

In the event of a medical emergency, I authorize staff of re.spire Children's Ministries to call local emergency services (911). *

I authorize emergency services (EMS) to transport the camper to a hospital in order to receive care in the event it is recommended by EMS. In this situation, every effort will be made to contact you. *

During camp hours, I authorize the staff of re.spire Children's Ministries to take my child off church property for a neighbourhood walk. Parents will be notified at least 24 hours in advance of these activities. During these excursions, all proper safety protocols will be followed. I acknowledge that incidents such as, but not limited to, falls, bites, pedestrian accidents, automotive accidents may occur and do not hold re.spire Children's Ministries or its staff responsible for any such incident. *

I authorize re.spire Children's Ministries Camp Staff to take photographs and videos of my child. These may be posted to social media for promotional material. *

I type my full name below acknowledging that I have read and understand this form. I give my consent for my child to participate in camp activities. *

Please type the date this form was completed on. *

YYYY

A copy of your responses will be emailed to the address you provided.

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