Ontario Christian Assembly Inc

Appendix 9

Ontario Christian Assembly Inc.

Registration Form – Overnight Summer Camp 2017

Overnight Camp / Grades / Dates of Camp / Check in
Time / Check out Time / Dean(s)
Primary Camp / 1-3 / Jul 14th to July 16th (Fri-Sun) / 4:00 pm / 11:00 am
Junior Camp / 4-6 / July 23rd to July 29th (Sun-Sat) / 4:00 pm / 11:00 am
Jr. High Camp / 7-8 / July 16thto July 23rd (Sun-Sun) / 4:00 pm / 11:00 am
Senior Camp / 9-12 / July 2nd to July 9th (Sun-Sun) / 4:00 pm / 12 noon
LIT CAMP / 10-12 / July 9th to July 29th / 2:00 pm / 12 noon / Jerry Maschewski and
Program Director
Worship Camp / 13 to 22 yrs / July 30th to Aug 4th
(Sunday to Friday) / 4:00 pm / 11:00 am

NOTES:

1.The school grade is the one being entered into Sept. 2017.

2.The family maximum cost for the above summer youth camps is $550.00. To qualify for this special rate, all campers must be registered at least 3 weeks before the first family member attends their week of camp.

The camp program at Ontario Christian Assembly is sponsored by the Christian Churches of Ontario. There is some free time and outdoor time available to the participants, but each participant is expected to participate in all the scheduled activities.

Here are some things to bring: Sleeping bag, jacket for cool nights, pillow, change of clothes, modest swimwear, insect repellent, Bible, notebook, camera, etc. Please do not bring lots of cash, since there is nothing to spend it on at the camp. You will be staying in cabins with 10 campers. If you have a musical instrument, bring it if you wish.

Cell phones, mp3 players, etc. are prohibited.

Camp Location and Contact Information

The camp is located North of Orangeville, along the Bruce trail. Take Highway 10 North from Orangeville until you come to a “T” end, which is Highway 89. Turn East onto 89, away from Shelburne, and go up the first hill. At the top of the hill you will see a sign for “Hurontario Street,” which is a gravel road. Turn right onto the road, then left at the gate into the camp. Follow the camp road down the hill to the camp site.

For more information, maps, etc., go to

Business phone: (905) 776-3847 email: Phone number only during camp (519) 925-5901

During the week of summer camp, mail may be sent directly to your camper at:

(Your Child’s Name)

c/o OCAI R.R. #4

Box B-1, Shelburne, ON L0N 1S8

Keep this page for your Reference – DO NOT MAIL THIS PAGE

Appendix 9

2017 Ontario Christian Assembly Inc.

If you wish to pay by Cheque or Money Order please complete pages 2, 3, 4 and 5 of this form and mail to address at bottom of page 5.

If you wish a year-end receipt please complete the following.

Family Name on Receipt: ______

First Name on Receipt: ______

Address: ______

City: ______Postal Code: ______

Phone Number: (______) ______-______Email Address: ______

Are you taking the bus from Church of Christ Christian Chapel in Selkirk? ______Yes

20 Erie Street North

Selkirk, ON

Are you taking the bus from Tile-It (Mountain View Christian Church)? ______Yes

3727 Upper James

Mount Hope, ON

Are you taking the bus from DC3 (Meadowvale Campus)? ______Yes

7755 Tenth Line

Mississauga, ON

If you are receiving a discount please enter Discount Code ______

 / Overnight
Camp / Grades / Dates of Camp / Check in Time / Check out Time / Camp
Fees / Early Registration Date / Early Registration Discount / Dean(s)
Primary Camp / 1-3 / July 14th to July 16th
(Fri-Sun) / 4:00 pm / 11:00 am / $94 / June 15, 2017 / $10
Junior Camp / 4-6 / July 23rd to July 29th
(Sun-Sat) / 4:00 pm / 11:00 am / $210 / June 15, 2017 / $20
Jr. High Camp / 7-8 / July 16th to July 23rd
(Sun-Sun) / 4:00 pm / 11:00 am / $230 / June 15, 2017 / $20
Senior Camp / 9-12 / July 2ndto July 9th
(Sun-Sun) / 4:00 pm / 12 noon / $230 / June 1, 2017 / $20
LIT CAMP / 10-12 / July 9th to July 29th / 2:00 pm / 12 noon / $350 / Separate Registration for LIT Camp – Use LIT Application Form (Appendix 6) / Jerry and
Program Director
Worship Camp / Ages 13 -22 yrs / July 30th to Aug 4th / 4:00 pm / 11:00 am / $225
 / Please check appropriate camp. There is a Family Maximum of $550.00 when paid before first camp attended.

2017 OCA CAMP FORM – Please complete this section and Mail

Registration Form – Overnight Summer Camp 2017

Information received is confidential and is being gathered for the purposes of serving your child while in the care of Ontario Christian Assembly Inc. Any medical information collected here serves to authorize Ontario Christian Assembly Inc., and its staff and volunteers, to obtain medical assistance in emergencies.

This form must be completed and signed in order for a child to attend Ontario Christian Assembly.

Parents’ Names ______

Appendix 12 - In the case of custody agreements, please include the proper form authorizing parental/custodial contacts.

Child’s Name ______Date of Birth ______

Grade in Fall ______

Address ______

Phone Number ______Parents’ Work Number ______

Health Card Number ______Parents’ Cell Number ______

Family Doctor ______Doctor’s Phone Number ______

Allergies ______

Does your child have any life threatening allergies that could cause  Yes  No

Anaphylactic Shock, requiring use of an EpiPen? If Yes, please call or email for information and forms for Individual Anaphylactic Plan (Appendix 13) Business phone: (905) 776-3847, email:

In case of an emergency, contact: ______

Phone/Cell: ______

Does your child have any physical, emotional, mental, behavioural  Yes  No

concerns or limitations that staff should be aware of?

If yes, please explain:

______

Appendix 9

Is your child bringing any medication with him/her?  Yes  No

If yes, please list.

______

The safety of your child is our primary concern. Precautions will be taken for their well-being

and protection.

I/we, the parents or guardians named below, authorize Dean or one of the Ontario Christian Assembly Inc. Ministry Personnel to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above.

I/we, named below, undertake and agree to indemnify and hold harmless Ministry Personnel, Ontario Christian Assembly Inc., its Deans and Board of Directors from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Ontario Christian Assembly Inc., as well as of any medical treatment authorized by the supervising individuals representing the Camp. This consent and authorization is effective only when participating in or traveling to/from events sponsored by the Ontario Christian Assembly, Inc.

Photos

Please sign below to grant permission for the reasonable use of pictures containing yourchild in any or all of the following ways:

 Brochures/Promotional materialCamp

 Website Newsletters

Videotaping

Purposes and Extent

Ontario Christian Assembly, Inc. is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to assign the camper to the appropriate classes, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our Camp. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Ontario Christian Assembly, Inc. to limit the information collected, or to view your child’s information, please contact us.

I have read, understood and agree with the above.

Parent/Guardian Signature ______

Printed Name ______Date ______

Appendix 9

Ontario Christian Assembly Inc.

Registration –Overnight Summer Camp 2017

Be sure to include with your Registration:

Registration Form - Appendix 9 – one for each child attending camp
Parental/Guardian Release Form – Appendix 12, if required. Required for campers under 6 years
Individual Anaphylactic Plan - Appendix 13, Call or email for further information and Correct Forms - Business phone: (905) 776-3847, email:
TreeTop Trekking Waiver Form: Jr High, Dated July 17th, 2017; Sr High, Dated July 3, 2017
Letter of Informed Consent Appendix 11, Junior and Senior High Campers
Please include your Registration Fee(s) or down payment when you mail your Registration Form

Camp Fees / T-Shirt Sizes – Please check correct size for your child
Camp Fee / $
TreeTop
Trekking / $35.00 / Junior and Senior High Camp(s) only / $
T-Shirt / $10.00 / Children’s Size: ( ) Small ( ) Medium ( ) Large ( ) X-Large ( ) 1X - Large / $
T-Shirt / $10.00 / Adult Size: ( ) Small ( ) Medium ( ) Large ( ) X-Large ( ) 1X - Large / $
Bus Use / $20.00 / $
Total / $
 / Please check all appropriate boxes and T-Shirt size.

✔ Week of Camp: ( ) Senior ( ) Jr. High ( ) Junior ( ) Primary ( ) Worship Camp

Registration Fee Enclosed (minimum deposit $25.00) ______

✔ ( ) Cheque ( ) Money Order/Bank Draft ( ) Cash (Note: Please do not mail cash)

The family maximum cost for 2017 summer youth camps is $570.00. To qualify for this special rate, all campers must be registered at least 4 weeks before the first family member attends his/her week of camp.

Note: Camps are limited to 60 campers maximum.

Dead line for Registration is 2 weeks prior to camp date. A Waiting List will be established and Campers on the list will be called if a cancellation is made. Calls will be in the order Registrations have been received. No “walk-in” registrations will be allowed unless approved by David Kindy. Unapproved “walk-ins” will be asked to go home if the camp is at maximum capacity.

MAIL THIS FORM TO:OCA

PO Box 194, Selkirk, ON

N0A 1P0