2020 Summer Camp - July 20th to 24th

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 NameLast Name
Date of Birth*

YearMonthDay
Add Second Child

N/AYes
Child 2*

First NameLast Name
Date of Birth*

YearMonthDay
Add Third Child

N/AYes
Child 3

First NameLast Name
Date of Birth

YearMonthDay
Add Fourth Child

N/AYes
Child 4

First NameLast Name
Date of Birth

YearMonthDay
Your Contact Information
Parent or Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone #*

Area CodePhone Number
Cell Phone #

Area CodePhone Number
E-mail Address*

Confirmation Email
How did you hear about Burns Camp?

FacebookAttended in a previous yearFriendOther
Emergency Contact/Health Information
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone #*

Area CodePhone 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?

NoYes
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.

YesNo
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).

YesNo
I AGREE (Parent/Guardian)

First NameLast Name
Date

YearMonthDay
Please enter the word(s) shown in the image:*
Should be Empty:

2022 Summer Camp - July 18th to 22nd

Register Your Child/Children

Your Contact Information

Emergency Contact/Health Information