2020 Camp Camino

Camper Information

Please complete a separate registration form for each child.

NEW: Additional siblings can be easily added using the link provided on the bottom of the Thank You page.

Camper's Name *

First Name Last Name

Camper's Email

Optional. ( Camp video and photo notifications only )

Birth Date *

Month Day Year

Health Card # *

Address

Street Address
Street Address Line 2
City	Province
Postal Code	Country

T-Shirt Size *

Straight-Cut= longer/wider

Camper's Parish *

Parent/Guardian Information

Parent/Guardian # 1 *

First Name Last Name

Home Number

Area Code Phone Number

Cell Number

Area Code Phone Number

Primary E-mail *

example@example.com

Parent/Guardian # 2

First Name Last Name

Home Number

Area Code Phone Number

Cell Number

Area Code Phone Number

Email

example@example.com

Emergency Information

Emergency Contact's Name # 1 *

First Name Last Name

Relationship

Home Number

Area Code Phone Number

Cell Number

Area Code Phone Number

Emergency Contact's Name # 2

First Name Last Name

Relationship

Home Number

Area Code Phone Number

Cell Number

Area Code Phone Number

Camper Medical Information

Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the camper prescribed any medications? If yes, please list all medications.

Permission for {CampersName} to Participate:

ACTIVITIES: Spiritual formation, Mass, Human formation activities, games, sports including water sports, camp fires, workshops, crafts, team projects, etc.
TRANSPORTATION: The participants are responsible for finding transportation to and from Providence Point. Transportation will be provided for any outing day if applicable.
WATER ACTIVITIES: I give my consent for {CampersName} to participate in swimming, canoeing, kayaking and all other water activities on the Clyde River during Camp Camino. I am aware that accidents and injury can occur while taking part in such activities. I will not hold Camp Camino or any of it's Supervisor(s), Leaders or Counsellors responsible for ANY injury, illness or death resulting from ANY activities.
HEALTH REQUIREMENTS: Particants MUST be in good health and have no physical or medical limitations that would cause the activities as described above to be detrimental or dangerous to the participant or others.
INSURANCE: I understand that Camp Camino does not carry any insurance relative to the activities or for any injury that may occur to {CampersName}. I hereby represent that {CampersName} is covered by insurance through my own insurance carrier.
EMERGENCIES: If {CampersName} requires any emergency medical treatment or procedures during camp, I hereby consent to and authorize the camp supervisor(s) to make any decisions and take any actions to arrange for such procedures or treatments at their discretion. Permission is also granted to {Organization} and its supervisor(s) to provide any needed emergency treatment prior to the child’s admission to a medical facility.
EMAIL PERMISSION: I agree to receive Email and other electronic communications regarding Camp Camino and related matters now and in the future.
POLICIES: {CamperName} agrees to abide by all the rules and regulations stated within the Camp Camino Policies document found on CampCamino.ca. I understand that Camp Camino leaders, supervisors and those transporting/accompanying the youth will not be held liable if my child fails to cooperate with the policies and that any infraction of the rules may result in immediate dismissal from the Camp at MY expense and without a refund. I will not hold the Camp liable for any missing personal items.
MEDIA PERMISSION: By registering for and/or attending this camp, photos and videos of {CamperName} at camp/camp activities may be published
in print or online at the sole discretion of Camp Camino.
RELEASE AND INDEMNIFICATION: I release, waive and further agree to indemnify, hold harmless and reimburse Camp Camino, the individual members, agents, employees, representatives thereof, activity supervisors as well as the Archdiocese of Kingston and the parish of Sacred Heart, Lanark, from and against, any claim which I, any other parent or guardian, any sibling, {CampersName} or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses, damages or injuries arising out of, during, or in connection with the child's participation in the activities (including all forms of transportation) or the rendering of emergency medical procedures or treatment, if any.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

I HEREBY ATTEST THAT I AM A LEGAL PARENT/GUARDIAN OF {CampersName} AND HEREBY CONSENT TO ALL ITEMS LISTED IN THE PERMISSION TO PARTICIPATE DOCUMENT ABOVE.

Parent/Guardian Signature *

Type your name.

Signed On: *

{parentguardianSignature}

Signed on: {signedOn}

I am applying for financial assistance through:

Jumpstart ( Canadian Tire ) www.jumpstart.canadiantire.ca Local Parish C.W.L. or Knights of Columbus Family and/or Friends ( donate through campcamino.ca - Support Us tab )

Payment Method *

Secure Credit Card Interac E-Transfer (through your bank's online banking) Cheque by Mail

Secure Credit Card - Receipt will be emailed to {primaryEmail}.

Deposit per Camper (Non-Refundable) $ 100 CAD

Remainder of Early Bird Registration Fee ( Due by July 1 ) $ 390 CAD

Multiple Siblings Registrations

Total $ 0.00 CAD

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Please send a cheque:

Dated Today, $100 - Deposit per Camper (Non-Refundable)
Dated July 1, 2020 - Remainder of Early Bird Registration Fee(s)
- First Child - $390
- Second and Additional Children - $345 each

Send the cheques to:

Camp Camino,
c/o Pat Neumann
244 Black Lake Rd.
Perth, ON
K7H 3C5

Please E-Transfer payments:

Today: $100 - Deposit per Camper (Non-Refundable)
July 1, 2020 - Remainer of Early Bird Registration Fee(s)
- First Child - $390
- Second and Additional Children - $345 each

Please send the payment to register@campcamino.ca

Please email the secret password to the same email address, once you have sent the funds.

Interac E-Transfer payments may be done through your own Bank's Online Banking.

Camp Camino 2020 Registration