Waymacres Boys Camp Registration Form

Camp Registration Form

These forms are required for your son(s) to attend camp.
Camper Information

If multiple campers are attending the same week(s) please complete one form but all necessary camper information sections. If multiple campers are attending different weeks, please complete separate forms.
Camper 1 Name*
Date of Birth*

MonthDayYear
Entering Grade in 2024/25*
NOTE - Boys who have completed Kindergarten through Grade 5 (going into Grade 1 - Grade 6) are invited to participate.
Camper 2 Name
Date of Birth

MonthDayYear
Entering Grade in 2024/25
Camper 3 Name
Date of Birth

MonthDayYear
Entering Grade in 2024/25
Camper Swimming Ability*

Child is able and allowed to swim without assistance and without use of any flotation deviceChild IS NOT able/allowed to swim while at camp
Pool on property is 48" deep, round above ground. All swimming opportunities will be adult supervised. Number of children allowed in the pool at one time will be limited.
Please provide any additional information that you think is important or may affect the camper's ability to fully participate in the camp program including any ACTIVITY RESTRICTIONS.*

Parents' Information

Parent/Guardian 1
Parent/Guardian 1*

First NameLast Name
Relationship to Child*
E-mail*
example@example.com
Cell Phone*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 2

First NameLast Name
Relationship to Child
Cell Phone
E-mail
example@example.com
Home Address Same as Parent/Guardian 1?

Yes
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact
Full Name*

First NameLast Name
Primary Phone Number*
Relationship to Child*
Additional Authorized Pick Up

Please send a note or a text to camp on the day of any alternate pick-up. If the third party is not listed here, please send this information with your text/note on the day of their authorized pick-up.
Would you like to add additional authorized pick-up at this time?

YesNo
Full Name

First NameLast Name
Primary Phone Number
Relationship to Child
Medical / Health Information
Name of Physician or Clinic/Hospital*
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Does your child have any food, medication or environmental allergies?*

YesNo
Allergies? Check all that apply*

FoodMedicationEnvironmentalOther
Please list and explain any allergies*
Does your child’s allergy/allergies require child care staff to monitor child for symptoms, take action if a reaction occurs, or give emergency medication to your child?*

YesNo
Does your child have a special health or medical condition?*

YesNo
Please explain*
Does the special health or medical condition require child care staff to perform a procedure, or perform child specific care such as: to monitor your child for symptoms or administer medication during child care hours?*

YesNo
Please explain*
If yes, does this medication, food supplement, or medical food need to be administered at the day camp?

YesNo
List any history of hospitalization, outpatient surgery, or previous health concerns that would be needed to assist the staff or medical personnel in an emergency situation.

0/200
List any additional information about your child that would be useful for staff to know, such as fears, eating or sleeping habits, or special routines. This information should not be medical or health related, as that information should be included in the previous questions.

0/200
Additional Medication
Check all that apply*

Prescription medicationNonprescription medicationRefrigeration requiredTopical product or lotionFood supplementModified dietNONE
Name of medication*
Exact dosage*
To be administered at the following times*
For the following period of time*
Statement of Understanding
Waymacres has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported.*
Type first and last name above to consent
Acknowledgement of Policies and Procedures: I have reviewed the policies and procedures and understand that a hard copy will be made available to me upon request.*

YesNo
Sign Document*
Date Signed*

MonthDayYear
Payment Calculator - Payment can be made in person by cash or check or Venmo to @Logan-Christine.*
prevnext( X )
Initial DepositDue at time of Registration
$50.00 Number of Weeks



Camper 1 Balance Due first day of camp week
$100.00 Number of Weeks



Second Camper$100 per week per additional camper. Total due on first day of camp
$100.00 Number of Weeks



Third Camper$100 per week per additional camper. Total due on first day of camp.
$100.00 Number of Weeks



Overnight Option$30 per night - will include dinner, breakfast, lunch the next day and farm chores :) Due on camper's first day of camp.
$30.00 # of Total Nights x # of Campers



Total

$0.00
Should be Empty:

Camp Registration Form

Camper Information

Schedule & Alternate Options

Parents' Information

Emergency Contact

Additional Authorized Pick Up

Medical / Health Information

Additional Medication

Statement of Understanding