Registration: First Baptist Church Ingersoll, Multi-Sports Day Camp

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Registration: First Baptist Church Ingersoll, Multi-Sports Day Camp

July 31st - August 4th 2023

9 am - 3 pm

Ages: 6 - 12

Registration Cost: $110 - 1 camper, $200 - 2 campers, $280 - 3 campers

Email *

Camper Name: *

Date of Birth:

YYYY

Health Card Number: *

Emergency Contact Info:

Name and Relationship to Camper:

Primary Phone Number: *

Medical Information:

Please list any medical conditions camp staff need to be aware of:

Please list any medications that your child is currently taking:

*Please Note: If your child requires medication while at camp, we ask that you make arrangements to administer the medicine throughout the day. We will not administer any medicine of any type for children at camp.

Are there any other problems that may affect your child's ability to participate in camp activities? *

T-Shirt Size (please select one): *

Parent/Guardian Name(s):

Residential Address: *

Home Phone Number: *

Cell Phone Number: *

E-mail Address:

Authorization #1: WAIVER

I acknowledge and understand that there are risks involved with my child's participation in the camp activities, including the risk of physical injury or damage to personal property and I release Scripture Union Canada, First Baptist Church Ingersoll Inc, and all sports camp staff and volunteer from liability. I understand that photographs and video recordings may be taken by SU which may be used in publications or promotions and I consent to SU using the images for all stated purposed. If you have a concern, please speak with the Camp coordinator before camp and arrangements will be made.

Parent/Guardian Signature:

Signature #1 Date: *

YYYY

Early Bird Registration Cost (Prior to July 10th): $110 - 1 camper, $200 - 2 campers, $280 - 3 campers

Regular Cost (After July 10th): $140 - 1 camper, $230 - 2 campers, $310 - 3 campers

Please indicate your preferred payment method:

Cheque payable to First Baptist Church Ingersoll

E-transfer to 'giving.fbingersoll@gmail.com'

Cash payable in person to the First Baptist Church Office

How did you hear about Sports Camp? *

Authorization #2: DISCLAIMER:

I am the legal guardian of the camper with full authority to make decisions with respect to the care, upbringing, and education of the applicant.

I agree that all of the medical information provided on the form is true and accurate - lacking nothing. I hereby release my child to the care and medical discretion of the staff at Scripture Union, First Baptist Church Ingersoll Inc., and volunteers. In the event of an emergency and that no one can be immediately contacted, my child will be taken to the hospital or a physician to be treated if deemed necessary by one of the camp staff, church staff or volunteers. I hereby authorize the physician and and nursing staff to undertake examination, investigation and necessary treatment of my child.

Parent/Guardian Signature:

Signature #2 Date: *

YYYY

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