Camp Registration Form
Summer Day Camp 2024
Camper's Name
*
First Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
Year
Gender
*
Please Select
Male
Female
Prefer not to disclose
Primary Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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School Information
What school do you attend?
Grade (going into)
*
Please Select
Preschool
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
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Family Information
Parent/Guardian's Name
*
First Name
Last Name
Contact Phone Number
*
Alternate Phone Number
E-mail Address
*
example@example.com
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Emergency Contact Information
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Relationship to Student
*
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Health Information
Provincial Health Care Number
*
Province of Health Care
*
Dietary Restrictions? (Please specify if restriction is an allergy)
(Campers bring a packed lunch. Snacks will be provided.)
Please describe all behavioural and/or medical conditions the camper may have:
Does the camper have any prescribed medications that we may need to administer?
*
May we publish photographs or videos of your child as they participate at Camp for positive promotional purposes, such as on our website, brochures, and other promotional materials?
*
Yes
No
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I agree to pay $125 per camper to Descent of the Holy Spirit Camp.
Please sign below acknowledging your agreement. Payment can be made by cheque or cash and we will contact you regarding payment details.
Type your name here:
*
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