CAMP AWESOME

Registration Form

Glen Cairn United Church

August 11-15, 2014

10:00 am - 3:00 pm

Fee: $65/child (ages 4 - 12 yrs.)

Registration Deadline is July 31st, 2014

Office use only

pd / chq / cash
received / entered

Child’s First Name ______Last Name ______

Parent’s First Name ______Last Name ______

Age: _____ Date of Birth: Year ______Month______Day______Female ______Male ______

Home Phone # ______Cell phone # ______

Adult’s email ______

Address ______

City ______Province ______Postal Code ______

Is there another child registered with whom your child would like to be? ______

(Your child will be placed according to their age group unless otherwise requested.)

Does the child registered on this form suffer from any medical condition or take any medication we should be aware of (including allergies)?______

What symptoms does this child display in response to an allergic reaction? ______

______

Provincial Health Card Number ______

Doctor’s Name ______Doctor’s Phone Number ______

Who should we notify in case of emergency during Camp Awesome?

1.Name ______Relationship ______

Phone # ______Cell phone # ______

2.Name ______Relationship ______

Phone # ______Cell phone # ______

The safety of the children is a primary concern of the Camp Awesome Program. During program hours, we endeavour to maintain the highest possible standards to ensure children in our care are safe. Our care and responsibility extends to ensuring that children are returned to an appropriate guardian when our program ends. As a result, parents and guardians are asked to sign their children into the program at the beginning of the day and out of the program at the end of the day.

…over

Name(s) of person/persons who will transport and sign child/children in and out are as follows:

______

______

Please note that children with special needs requiring one-on-one must be accompanied by their own helper

Parent/Guardian Agreement

Please read and sign the following:

I (we) give permission for ______to attend Camp Awesome at Glen Cairn United Church. I understand that while all reasonable precautions will be taken, GlenCairnUnitedChurch, the Ottawa Presbytery of the United Church of Canada, and its affiliated organizations and individuals will not be held responsible in any way for injuries sustained by your child as a result of his/her participation in CampAwesome.

I (we) understand that, in the event medical treatment is required, every effort will be made to contact me. However, if I cannot be reached, I give permission to the staff of CampAwesome to secure the services of a licensed physician to provide the care necessary for my child’s well-being.

Signed ______Date ______

I give permission for photographs taken while at CampAwesome to be used for publicity and promotion of CampAwesome and the Ottawa Presbytery.

Signed ______Date ______

Fee: $65.00- cash or chequepayable to Glen Cairn United Church. Your child is not considered registered until the fee has been paid in full. Please remit payment with this form to the church office or place in the mail slot in the door of the office.

Please bring: Everyday - nut free lunch*, sunscreen, hat.

Provided: CampAwesome will provide a morning and afternoon nut free snack.

* We encourage all lunches to be nut free due to increased nut allergies.

If you have any questions, please call or email Celia Bodnar at 613-836-7907 () or the church office at 613-836-4756 ().