Camp MacLeod Registration Form 2023

Camp MacLeod Registration Form

Summer 2023
Camp Attending
Camp MacLeod Week Schedule 2023:*

Junior Co-Ed #1 - July 3rd - 9th (ages 9-11)Intermediate Co-Ed #1 - July 10th - 16th) (ages 12-14)Junior Co-Ed #2 - July 17th - 23rd (ages 9-11)Intermediate Co-Ed #2 - July 24th - 30th (ages 12-14)Novice Co-Ed - July 31st - August 3rd (ages 7-8)Junior Co-Ed #3 - August 7th - 13th (ages 9-11)Junior Co-Ed #4 - August 14th - 20th (ages 9-11)Intermediate Co-Ed #3 - August 21st - 27th (ages 12-14)
Camp 2023 Rates:

Junior Coed/ Intermediate Co-ed/: $200.00

7 days/6 nights

Novice Co-Ed : $125.00

4 days / 3 nights

** All prices are tax included. Rate includes all necessities + canteen and camp photo**

15% off for second and third child. Also a second or third week attending.

Campships:

Financial assistance is available to campers in need. A recommendation from your minister/priest must accompany a request. Contact camp director for more information.

Camper Information
Child's Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age as of July 1st 2023:*
Male or Female*

MaleFemale
School Grade Completed*
Parent/Guardian Name(s)*

First NameLast Name
Parent/Guardian Name(s)

First NameLast Name
Parent/Guardian Email*
example@example.com
Home or Cell Phone*

Area CodePhone Number
Work Phone

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact*

First NameLast Name
Relationship to Camper (Emergency Contact)

GrandparentAunt/UncleSiblingFamily FriendOther
Emergency Contact Number*

Area CodePhone Number
Emergency Contact Work Phone

Area CodePhone Number
Emergency Contact Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Church/Clergy If Applicable

Camper Health Information
Health Card Number*
Health Concerns (diet/ allergies/ chronic conditions or special considerations we should be aware of as we prepare for your camper):*
If your camper has had any other operations or serious injuries please explain:*
To care for your child to the best of our ability, please describe any other physical, emotional, or behavioural problems:*
Has your child been exposed to or suffered from any infectious disease during the three weeks prior to the first day of camp? For Example: Measles, Mumps, Chicken Pox, Tuberculosis, Whopping Cough, H1N1, Mononucleosis, Covid19, etc. If “Yes” please contact Camp Director before coming to camp.*

YesNo
Date of last immunizations (roughly if not sure exact date)
My daughter has been informed about menstruation prior to Camp:

YesNo

Camper Medication (if applicable): all medication must be given to Camp Director in original packaging from the pharmacy on opening day.

Rows	Illness/Condition	Medication Name	Dosage	Time of Day Given
Medication (1)
Medication (2)
Medication (3)

Recent changes in Family (death, illness, divorce, etc)
Waiver Form
Parent/Guardian: By signing below, you acknowledge that:1 .All registration forms must be accompanied by a $25 non-refundable deposit. Campers are registered when cheque/cash/e-transfer has been deposited and cleared. Payment in full is due upon arrival on opening day of your child’s camp.2. Although every effort is made to send campers home with all of their belongings, Camp MacLeod is not responsible for any loss or damage.3. Your child will follow all reasonable instructions from the staff of Camp MacLeod while participating in the program.4. Camp MacLeod reserves the right to cancel a child’s participation in a camp session if their behavior is deemed unmanageable or dangerous to themselves or others, in which case they will be sent home immediately.5. You release Camp MacLeod, its staff, volunteers and the Cape Breton Presbytery of and from all manner of actions, claim and demands of whatever nature which result from any loss, injury or expense sustained, arising out of or in any way connected with participation in any program or attendance at a location operated by Camp MacLeod.6. In the event your child is injured, ill or in need of medical attention and you are unable to be contacted, you authorize Camp MacLeod staff to seek medical attention on your behalf. 7. Prorated refunds apply for early dismissal. No refund for early dismissal for misbehaviour.*

Clear
Please Note: Head Lice; Parents/Guardians of children identified with head lice or nets will be notified by the camp director and will be required to seek treatment for the child. It is recommended that other members of the household be checked as well. The parent/guardian is required to pick up the child immediately and keep them home until the problem is cleared. Once the problem is cleared the child is welcome back. Please Initial When Read.*
Please Note: You (Parent) and your doctor are responsible for the health of your camper; this form should clearly indicate their health status. The camp staff will do the utmost to contact the family if an emergency arises; however, the signature on this form signifies that permission is granted for camp staff to arrange for medical attention with the local doctor and for that Doctor to provide any necessary treatment and that having taken such precautions as in the discretion of Camp MacLeod as are deemed advisable, Camp MacLeod shall not be held responsible for any accident or illness involving my child.

Clear
You authorize Camp MacLeod to use any photographs taken of your child while participating in Camp MacLeod programs for future promotional materials*

Clear
After your application has been submitted, you should receive a email from us containing a Information Booklet. Please check your spam/junk folder if you cannot see it in your main inbox. If you did not receive the information booklet please check our pinned post on Facebook or send us an email at campmacleoddirector@gmail.com.
Thank you 😃
Should be Empty:

Camp MacLeod Registration Form

Camp Attending

Camper Information

Camper Health Information

Waiver Form