Camp Keir Retreats
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Name *
Email *
Mailing Address *
Age *
Gender *
Which Retreat are you registering for? *
Allergies *
Any Dietary Restrictions? *
Any past medical history or current medical conditions we need to know about? *
Do you have any medical or physical restrictions? If so, what? *
In case of emergency, please list 2 DIFFERENT people that we may notify. Please include their contact information: *
Waiver & Conditions of Enrollment: The participant, release Camp Keir, staff, and agents from any loss, personal injury, accident, misfortune, or damage to the named applicant on this form or his/her property, with the understanding that reasonable precautions shall be taken to ensure the health and safety of the named applicant on this form. Each participant must be covered by PEI Medicare or equivalent medical insurance. The Camp Director reserves the right to dismiss a participant who, in his/her opinion, is a hazard to the safety and rights of others, or who appear to have rejected the reasonable controls of the camp. *
Camp Keir's Covenant: "I will follow the rules set out by the staff at Camp Keir while I am attending camp. I understand that if I do not follow these rules I may be asked to leave."  Please check below if you agree to these terms. *
Copyright and/or use photographic representations of participants, in various forms of media used by photographers and computer artists to assist the camp, including to use in publicity, promotion, camp advancement, marketing, and/or educational purposes, including the use of any printed or multi-media materials for Camp Keir. I hereby realize and accept that this is on a voluntary basis and no financial remuneration will be received from the photographer, Camp Keir, or any firm publishing and/or distributing the finished product. I have read, understand and agree to this release. *
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