COTRF Summer Camp Registration Form

Last Name*

First Name*

Middle Name

Birth Date*

MonthDayYear

Gender*

MaleFemale

Address*

City*

Province*

Postal Code*

First Time Camper?*

YesNo

Grade entering in the fall*

Please select Adventure Camp weeks for attendance*

Camper Interests & Summer Goals:

What interest/goal does your child have or would like to explore or discover...

Parent/Legal Guardian*

Relation*

Work Phone*

Area CodePhone Number

Cell Phone

Area CodePhone Number

Parent /Legal Guardian 2

Relation 2

Work Phone 2

Area CodePhone Number

Cell Phone 2

Area CodePhone Number

Home Phone

Area CodePhone Number

Emergency Contact Name(if parent or guardian is not avaliable)*

Emergency Number*

Area CodePhone Number

Emergency Number #2*

Area CodePhone Number

Parents Email (camper confirmation will be sent by email, if left blank it will be mailed)*

example@example.com

How did you hear about COTRF Summer Camp?

(OHIP) Health Card #*

Are your child's immunizations up to date?

YesNo

Any activity the camper should be restricted from?

Any physical, mental or other condition that would require special attention or medication while at camp?

List any allergies (ex: bees,peanuts, dairy)

Any dietary needs that we should know about?

I agree that photos of my child can be taken on used on for camp social media purposes*

YesNo

Method of Payment*

Pay Later (e-transfer to cleftofthetrock@gmail.com, use password: bestcamp )

ONLY SELECT A PRODUCT IF PAYING NOW (PAYPAL) ABOVE.

Be certain to enter your email address correctly on the registration form to receive confirmation via email with in 5-7 business days.

**All contact information is kept confidential and not shared with any party outside of the The Cleft of the Rock Foundation Summer Camp Program.

By hitting submit and putting your initials, you agree that

you are the parent or legal guardian of the above named camper, and are over the age of 18.
in case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel
I understand that the above named camper will only be released to the names listed above, an update may be done at registration.
I certify that my child has my permission to attend camp and participate in all activites. I assume full responsibility for my son/daughter's participation. The Cleft of the Rock Foundation Summer Camp, the camp director and staff, will not be held responsible for any injury or illness incurred while my son/daughter is at camp.
I agree to the conditions of enrollment as set out in the current Cleft of the Rock Foundation Summer Camp
Maximum 20 campers. Minimum 10 students for the program to begin. Cleft of the Rock Foundation Summer Camp reserves the right to cancel the Session should minimum enrollment not be reached.

Electronic signature, please initials*

Cleft of the Rock Foundation

Camper's Information

Notice of Warning

Parent or Legal Guardian Information

Emergency Contact Info

Email Confirmation

Other Information

Health Information

Camper Photo Release

Payment Information