Knox Camps Camper Application Form 2012

Camper Application Form
Parent or Guardian Information
Parent's Name

First NameLast Name
E-mail
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell Phone Number

Area CodePhone Number
Home Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
How did you hear about Knox Camps?
If other, please specify how you heard of Knox Camps. Thank you!
- Full Name
  
  First NameLast Name
- Birth Date
  
  MonthDayYear
- Gender
- Health Card Number
  Required If Available
- Family Doctor's Name
- Dr.'s Phone Number
  
  Area CodePhone Number
- Camp Registration
  
  Day Camp: $90 per week.
  
  extended care available weekly:
  
  $45 for 8:00-5:30
  
  $25 for only 8:00-9:30 or only 4:00-5:30
  
  Overnight Camp: $395.*
  *No tax, apologies for confusion in previous advertising.
- DAYCAMP
- Day Camp (ages 6-11)
- Day Camp: Jr.High Program (ages 12-14)
- ***Extended Care is not offered with the Jr.High Program.
- Day Camp Extended Care
- Do you need the above checked extended care for all the weeks registered for?
- If you checked "no", please indicate which weeks registered for that you also require extended care.
- OVERNIGHT CAMP
- Knox Overnight Camp dates: Sunday August 26 to Saturday September 1, 2012.
- Overnight Camp (ages 6-16)
- T-Shirt Size
- Friend Requests for Cabin Placement
- While we will try our best, friend request may not always be accomodated.
- Instructional Sign-Up (For Overnight Camp Registration Only)
  
  Please enter the top four instructionals the camper prefers. They will be placed into only two instructionals, and we will try our best to place them in their top two choices. Please choose four different instructionals. The only exception would be Sports, which one can sign up for twice.
  
  Campers who canoe should be comfortable with basic swimming.
  
  Instructionals will be filled on a first-come, first-serve basis. We may not be able to accomodate every request.
- 1st Choice
- 2nd Choice
- 3rd Choice
- 4th Choice
- Medical Information
- Please indicate which of the following the camper has had:
- Does the camper experience any of the following conditions with any degree of frequency?
- Has the camper ever received a full course of immunization against:
- Has the camper ever had a serious accident, illness or operation? If so, please describe:
- When was the last booster shot?
- Is the camper allergic to drugs?
- If yes, please describe:
- Is there any food which the camper cannot eat because of allergies or other medical problems? Any non-medical food restrictions?
- If yes, please describe:
- Does the camper require any medication or treatment while at camp?
- If yes, please describe:
- Is the camper able to participate fully in all camp activities without restriction?
- If no, please describe:
- Please check off any of the options that apply to your child.
- If you checked a box above, please describe your child's needs and the kind of support your child needs at camp.
- We will do our best to serve and support your child at camp. However, if we are unable to provide the support needed, you will be notified.
- Are there any additional issues (health-related or behavioural) that we should be informed about?
- If yes, please describe:
- Full Name
  
  First NameLast Name
- Birth Date
  
  MonthDayYear
- Gender
- Health Card Number
  Required If Available
- Family Doctor's Name
- Dr.'s Phone Number
  
  Area CodePhone Number
- Camp Registration
  
  Day Camp: $90 per week.
  
  extended care available weekly:
  
  $45 for 8:00-5:30
  
  $25 for only 8:00-9:30 or only 4:00-5:30
  
  Overnight Camp: $395.*
  *No tax, apologies for confusion in previous advertising.
- Day Camp
- Day Camp: Jr.High Program (ages 12-14)
- ***Extended Care is not offered with the Jr.High Program.
- Day Camp Extended Care
- Do you need the above checked extended care for all the weeks registered for?
- If you checked "no", please indicate which weeks registered for that you also require extended care.
- Overnight Camp
- T-Shirt Size
- Friend Requests for Cabin Placement
- While we will try our best, friend request may not always be accomodated.
- Instructional Sign-Up (For Overnight Camp Registration Only)
  
  Please enter the top four instructionals the camper prefers. They will be placed into only two instructionals, and we will try our best to place them in their top two choices. Please choose four different instructionals. The only exception would be Sports, which one can sign up for twice.
  
  Campers who canoe should be comfortable with basic swimming.
  
  Instructionals will be filled on a first-come, first-serve basis. We may not be able to accomodate every request.
- 1st Choice
- 2nd Choice
- 3rd Choice
- 4th Choice
- Medical Information
- Please indicate which of the following the camper has had:
- Does the camper experience any of the following conditions with any degree of frequency?
- Has the camper ever received a full course of immunization against:
- When was the last booster shot administered?
- Is the camper allergic to drugs?
- If yes, please describe:
- Is there any food which the camper cannot eat because of allergies or other medical problems? Any non-medical food restrictions?
- If yes, please describe:
- Does the camper require any medication or treatment while at camp?
- If yes, please describe:
- Is the camper able to participate fully in all camp activities without restriction?
- If no, please describe:
- Please check off any of the options that apply to your child.
- If you checked a box above, please describe your child's needs and the kind of support your child needs at camp.
- We will do our best to serve and support your child at camp. However, if we are unable to provide the support needed, you will be notified.
- Are there any additional issues (health-related or behavioural) that we should be informed about?
- If yes, please describe:
- Full Name
  
  First NameLast Name
- Birth Date
  
  MonthDayYear
- Gender
- Health Card Number
  Required If Available
- Family Doctor's Name
- Dr.'s Phone Number
  
  Area CodePhone Number
- Camp Registration
  
  Day Camp: $90 per week.
  
  extended care available weekly:
  
  $45 for 8:00-5:30
  
  $25 for only 8:00-9:30 or only 4:00-5:30
  
  Overnight Camp: $395.*
  *No tax, apologies for confusion in previous advertising.
- Day Camp
- Day Camp: Jr.High Program (ages 12-14)
- ***Extended Care is not offered with the Jr.High Program.
- Day Camp Extended Care
- Do you need the above checked extended care for all the weeks registered for?
- If you checked "no", please indicate which weeks registered for that you also require extended care.
- Overnight Camp
- T-Shirt Size
- Friend Requests for Cabin Placement
- While we will try our best, friend request may not always be accomodated.
- Instructional Sign-Up (For Overnight Camp Registration Only)
  
  Please enter the top four instructionals the camper prefers. They will be placed into only two instructionals, and we will try our best to place them in their top two choices. Please choose four different instructionals. The only exception would be Sports, which one can sign up for twice.
  
  Campers who canoe should be comfortable with basic swimming.
  
  Instructionals will be filled on a first-come, first-serve basis. We may not be able to accomodate every request.
- 1st Choice
- 2nd Choice
- 3rd Choice
- 4th Choice
- Medical Information
- Please indicate which of the following the camper has had:
- Does the camper experience any of the following conditions with any degree of frequency?
- Has the camper ever received a full course of immunization against:
- When was the last booster shot administered?
- Is the camper allergic to drugs?
- If yes, please describe:
- Is there any food which the camper cannot eat because of allergies or other medical problems? Any non-medical food restrictions?
- If yes, please describe:
- Does the camper require any medication or treatment while at camp?
- If yes, please describe:
- Is the camper able to participate fully in all camp activities without restriction?
- If no, please describe:
- Please check off any of the options that apply to your child.
- If you checked a box above, please describe your child's needs and the kind of support your child needs at camp.
- We will do our best to serve and support your child at camp. However, if we are unable to provide the support needed, you will be notified.
- Are there any additional issues (health-related or behavioural) that we should be informed about?
- If yes, please describe:
- Full Name
  
  First NameLast Name
- Birth Date
  
  MonthDayYear
- Gender
- Health Card Number
  Required If Available
- Family Doctor's Name
- Dr.'s Phone Number
  
  Area CodePhone Number
- Camp Registration
  
  Day Camp: $90 per week.
  
  extended care available weekly:
  
  $45 for 8:00-5:30
  
  $25 for only 8:00-9:30 or only 4:00-5:30
  
  Overnight Camp: $395 +tax.
- Day Camp
- Day Camp: Jr.High Program (ages 12-14)
- ***Extended Care is not offered with the Jr.High Program.
- Day Camp Extended Care
- Do you need the above checked extended care for all the weeks registered for?
- If you checked "no", please indicate which weeks registered for that you also require extended care.
- Overnight Camp
- T-Shirt Size
- Friend Requests for Cabin Placement
- While we will try our best, friend request may not always be accomodated.
- Instructional Sign-Up (For Overnight Camp Registration Only)
  
  Please enter the top four instructionals the camper prefers. They will be placed into only two instructionals, and we will try our best to place them in their top two choices. Please choose four different instructionals. The only exception would be Sports, which one can sign up for twice.
  
  Campers who canoe should be comfortable with basic swimming.
  
  Instructionals will be filled on a first-come, first-serve basis. We may not be able to accomodate every request.
- 1st Choice
- 2nd Choice
- 3rd Choice
- 4th Choice
- Medical Information
- Please indicate which of the following the camper has had:
- Does the camper experience any of the following conditions with any degree of frequency?
- Has the camper ever received a full course of immunization against:
- When was the last booster shot administered?
- Is the camper allergic to drugs?
- If yes, please describe:
- Is there any food which the camper cannot eat because of allergies or other medical problems? Any non-medical food restrictions?
- If yes, please describe:
- Does the camper require any medication or treatment while at camp?
- If yes, please describe:
- Is the camper able to participate fully in all camp activities without restriction?
- If no, please describe:
- Please check off any of the options that apply to your child.
- If you checked a box above, please describe your child's needs and the kind of support your child needs at camp.
- We will do our best to serve and support your child at camp. However, if we are unable to provide the support needed, you will be notified.
- Are there any additional issues (health-related or behavioural) that we should be informed about?
- If yes, please describe:
- I have read and agree to the following waivers and conditions:
- 1. The acceptance by the camp of this registration and the signature of the parent or guardian shall give the camp director the right to arrange for any special services or other requirements necessary in the best interests of the camper, and shall give the camp director the right to obtain or approve any medical attention necessary to the camper’s welfare and good health and the parent or guardian hereby agrees to pay for such services as may be required as indicated above.
  
  2. While every precaution is taken to ensure the good welfare and protection of the camper, Knox Church, its directors and staff, or the employees of facilities outside of camp grounds are hereby released from any and all liability in the event of any accident or misfortune that may occur to the camper.
  
  3. In signing this application, the parent or guardian certiﬁes that the applicant is normal in condition and habits and is amenable to necessary discipline.
  
  4. The parent or guardian permits photographs, video, or recorded audio of the camper to be used for Knox Camp use only (promotion & group photo distribution–in print and online.)
  
  5. The parent or guardian acknowledges that to become fully registered, a submission of a cheque deposit of $100 per camper (or if total registration fees are less than $100, the total registration fee) must be made payable to KNOX PRESBYTERIAN CHURCH and sent to:
  
  Knox Camps
  630 Spadina Ave.
  Toronto, ON
  M5S 2H4
  
  Be sure to include the name of the camper(s) in the memo line of the cheque.
  ***Please note: all deposits and paid registration fees are non-refundable.
- Name
- Date
  
  MonthDayYearHourMinutesAM/PM Option
- Thank You!
- Thank you for registering with Knox Camps!
  
  Soon, you will receive a confirmation email of your submission.
  
  We're looking forward to a fun summer ahead!
- Should be Empty:

Camper Application Form

DAYCAMP

OVERNIGHT CAMP

Thank You!