Youth Camp 2024 Registration

Youth Camp 2024 Registration

August 20th to 25th 2024 - Manhattan Beach Retreat Centre
Camper's Information
Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade (entering this fall)*
If you are coming with a Youth Group, which one?
Please note if you have any specific friends that you would like to be roomed with. We cannot guarentee this will take place, but we will do our best!
T-shirt Size:*

SmallMediumLargeX-Large2X-Large
Parent / Guardian Information
Name*

First NameLast Name
Email*
example@example.com
Contact Phone*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship with the Camper*
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Medical Information
MB Medical Personal ID Number (9 digit)*
MB Medical Registration Number (6 digit)*
Doctor's Name & Phone Number
Please list any physical, emotional, behavioural concerns that may require special consideration
List Any Allergies and Dietary Restrictions
Medications & Frequency
Please check any items you DO NOT want administered to your child

TYLENOLTUMSGRAVOLPEPTO BISMALLOZENGESCALAMINE LOTIONOINTMENT
Parent & Camper Agreements
I allow photos & videos of my child to be used for promotional and advertisings use.*

YesNo
PARENT/GUARDIAN PERMISSION/RELEASE. - I hereby released from liability. In the event that my child requires special medication, x-rays or treatment, the parent/guardian will be notified immediately. In case of surgical emergency, I hereby give permission to the physician selected by Youth Camp to hospitalize, secure proper treatment for and to order injection, anesthesia or surgery for my child as named above.*

Yes
CAMPER PLEDGE. - "I promise to respect myself, other campers, and their property. I promise to be engaged in the activities of camp, respect the camp property and environment, and obey the rules set out by the leadership team of Youth Camp and all Camp Staff.*

Yes
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Youth Camp Registration$370.00CAD
Youth Camp Registration

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Youth Camp 2024 Registration

Camper's Information

Parent / Guardian Information

Medical Information

Parent & Camper Agreements