Roblin Teen Camp 2023 Registration Form

Camp Information

2023 Teen Camp - August 6-11, 2023

Registration Fee: $250/camper, Family Rate Available

Payment and can be made via e-transfer to the camp at roblincamp@gmail.com (please put registrants name in memo line)

or on Day of Camp by:

Cash or
Cheque (made payable to ROBLIN HOLINESS CAMP)

Camper Info

Camper's Name*

First NameLast Name

Birth Date*

MonthDayYear

Age*

Gender*

MaleFemale

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Does your child have any siblings attending camp this year as well? If so, please name them here.

PARENT/GUARDIAN #1 INFORMATION

Name*

First NameLast Name

Home Number*

Cell Number

E-mail

example@example.com

EMERGENCY INFORMATION

Emergency Contact #1 Name*

First NameLast Name

Relationship

Phone Number*

Alt. Phone Number

Emergency Contact #2 Name*

First NameLast Name

Relationship

Phone Number*

Alt. Phone Number

Child's Health Card #*

ALLERGY INFORMATION

Does your child have any allergies

YesNo

Does your child require an EpiPen

YesNo

Description (be Specific)

Does your child have asthma?

YesNo

Indicate Severity

MildModerateSevere

Are there any other conditions we need to be aware of?

LOSS/THEFT AND VANDALISM

Roblin Christian Camp is not responsible for lost, stolen or misplaced belongings of any kind. All valuables and belongings are brought to the camp at the risk of the participant. Roblin Christian Camp reserves the right to change any user of our site should equipment be intentionally broken, vandalized, or destroyed.

I have read and agree to the above.*

YesNo

REMOVAL FROM CAMP PROGRAM

I, the undersigned custodial parent/guardian of the participant, understand and agree that intentional behaviour by a participant that puts the participant or others at physical or emotional risk may result in dismissal from the Teen Camp program. In addition, possession of alcohol, tobacco products and/or illegal or hamful substances will result in dismissal from the Teen Camp program. Any expenses incurred due to dismissal from the Teen Camp program will be my sole responsibility. I, or a person I have designated in writing, must be available to pick up my child should he/she be dismissed from the Teen Camp program or should any emergency arise which requires emergency transportation of my child. I acknowledge that no refund will be provided to participants leaving camp prior to the end of the session due to disciplinary action.

I have read and agree to the above.*

YesNo

ASSUMPTION AND ACKNOWLEDGEMENT OF RISK

I understand that there are always risks involved in any activity based camp whether on or off the property. I have been given the opportunity to inquire about the safety and behaviour standards enforced at Roblin Christian Camp. I understand that despite all reasonable precautions being in place to provide proper organization, supervision, and equipment for all activities, circumstances may arise which are not foreseeable or which are beyond the control of Roblin Christian Camp. I understand and acknowledge that Roblin Christian Camp is not responsible for any damages caused by the delay or failure to perform or complete any activities or to provide any transportation or accommodation related to the program when the delay or failure is due to fires, strickes, floods, acts of God, lawful acts of public authories, or delays or defaults caused by common carriers, which cannot reasonably be foreseen or provided against.

I acknowledge and assume any and all risks associated with my child's participation in the program. I wish for my child to participate in the program.

I further acknowledge that I have discussed with my child his/her obligations to follow Roblin Christian Camp rules, regulations, policies and procedures so as not to endanger fellow participants and staff and to ensure the camp experience enjoyable for all participants. I believe that my child understands his/her obligations in this respect and the consequences of any misconduct.

I have read and agree to the above.*

YesNo

CONSENT AND MEDICAL AUTHORIZATION

By registering my child for Teen Camp at Roblin Christian Camp, I am providing my consent for him/her to participate in all Camp activities. To the best of my knowledge, my child is in good health.

I have disclosed all of the necessary information about my child's needs and abilities on the registration form. I am aware that my child may be removed from the Camp program if I fail to share the requested information with Roblin Christian Camp staff. I will inform Roblin Christian Camp of any changes to my child's health. I certify that my child meets the required age, and is emotionally and physically capable of participating in the activities for which he/she is registered. I will notify Roblin Christian Camp if my child is exposed to an infectious disease during the two weeks prior to arriving at camp.

I authorize Roblin Christian Camp staff to administer my child any required medication as outlined in this information package. In case of emergency, I grant Roblin Christian Camp staff authority to act on my behalf.

If there is a custodial order/arrangement in place for the custody of my child, I acknowledge that I am required to provide the custodial order/arrangement to Roblin Christian Camp staff prior to the commencement of the Teen Camp program. I acknowledge that my child may not be permitted to attend camp without this.

I am the custodial parent and/or legal guardian of my child*

YesNo

I have read and agree to the above.*

YesNo

RELEASE, INDEMNITY AND WAIVER

In exchange for Roblin Christian Camp permitting my child to participate in the program, I hereby release and indemnify Roblin Christian Camp , including its respective directors, employees, volunteers and agents, and their successors and assigns, from any and all claims arising from, connected with, or in preparation for, participation in Teen Camp program or activities, including for personal injury and property damage sustained in consequence of loss, injury or damage to me or my child, howsoever caused, including any and all claims in tort, negligency or breach of contract.

Furthermore, I waive any and all rights to participating in a class action lawsuit against Roblin Christian Camp .

Any claims and/or lawsuits against Roblin Christian Camp , including its directors, staff, volunteers, agents or assigns, shall take place under the exclusive jurisdiction of the laws and regulations of Ontario, and the applicable law to be applied to any dispute shall be the laws of Ontario.

In order to ensure the safety and well-being of all participants, I acknowledge that Roblin Christian Camp reserves the right to alter the program at any time without compensation to participants, parents or guardians. I agree to assume any expense(s) arising from program dismissal.

I confirm that all legal guardians have read and are in agreement with the above AUTHORIZATION, ASSUMPTION, RELEASE AND INDEMNITY and that all legal guardians have read and agree to abide by Roblin Christian Camp 's terms and conditions. As the custodial parent and/or legal guardian, I have the authority to sign on behalf of my child.

In signing this AUTHORIZATION, ASSUMPTION, RELEASE AND INDEMNITY, I consent to my child (named above), participating in Roblin Teen Camp.

Custodial Parent/Guardian's Signature*

Clear

Date*

MonthDayYear

Name*

First NameLast Name

I GIVE Roblin Christian Camp permission to

use my child's picture for promotional purposes (print in camp brochures, show in church services, etc.)

I DO NOT GIVE Roblin Christian Camp permission to

use my child's picture for promotional purposes (print in camp brochures, show in church services, etc.)

Custodial Parent/Guardian's Signature*

Clear

Date*

MonthDayYear

Name*

First NameLast Name

Roblin Teen Camp Registration

PHOTO RELEASE FORM