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:
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
Parent & Camper Agreements
I allow photos & videos of my child to be used for promotional and advertisings use.
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.
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.
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Youth Camp Registration$370.00 CAD
Youth Camp Registration

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Total $0.00 CAD
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Date
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Youth Camp 2024 Registration

Camper's Information

Parent / Guardian Information

Medical Information

Parent & Camper Agreements

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