2022 Summer Camp - July 18th to 22nd
Camper Registration Form (no fees)
Register Your Child/Children
Spots are limited, register early!
This form is for campers from Grades 1-6 (Fall ’22).
Child 1
*
First Name
Last Name
Date of Birth
*
-
Year
-
Month
Day
Date Picker Icon
Add Second Child
N/A
Yes
Child 2
*
First Name
Last Name
Date of Birth
*
-
Year
-
Month
Day
Date Picker Icon
Add Third Child
N/A
Yes
Child 3
First Name
Last Name
Date of Birth
-
Year
-
Month
Day
Date Picker Icon
Add Fourth Child
N/A
Yes
Child 4
First Name
Last Name
Date of Birth
-
Year
-
Month
Day
Date Picker Icon
Your Contact Information
Parent or Guardian Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone #
*
-
Area Code
Phone Number
Cell Phone #
-
Area Code
Phone Number
E-mail Address
*
Confirmation Email
How did you hear about Burns Camp?
Facebook
Attended in a previous year
Friend
Other
Emergency Contact/Health Information
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone #
*
-
Area Code
Phone Number
Health Concerns/Allergies
*
N/A
What will make your child’s stay with us most enjoyable? This information will be kept confidential and will only be used to facilitate your child’s comfort in our programs.
Are there other camper(s) that your child would like to be grouped with?
No
Yes
List up to three friends:(We will make every attempt to fill requests, though we cannot guarantee)
I give full permission to Burns Presbyterian Church to use my child’s photograph, still or video, in connection with their activities and I consent to use of such material or its reproduction in any manner and by any medium which Burns Presbyterian Church, at their sole discretion, deems appropriate.
Yes
No
I am aware and give my permission for my children named in this registration to participate in Burns Camp activities off church property, at Ashburn Community Centre (across the street from the church) and Ashburn Park (taking a short trail walk that begins behind the Community Centre).
Yes
No
I AGREE (Parent/Guardian)
First Name
Last Name
Date
-
Year
-
Month
Day
Date Picker Icon
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*
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