Youth Camp 2026 Registration

Youth Camp 2026 Registration

June 30-July 5- Manhattan Beach Retreat Centre
Camper's Information
Name*

First NameLast Name
Birth Date*

MonthDayYear
Sex*

FemaleMale
Grade (entering this fall)*
What youth group do you attend?
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!
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
I have read the Updated Camper Cellphone Policy*

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
Date*

MonthDayYear
Date
My Products
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Early Bird Registration $395.00CAD
Youth Camp Registration on or before June 15 $395. After June 15, $415. Registration closes June 23rd at 5pm.

Quantity
Item subtotal:$0.00CAD

Total $0.00CAD
Payment Options

E Transfer - mbnwo@paoc.netFor online payment https://www.paoc.net/donate
Do you require Financial Assistance

Yes
Should be Empty:

Youth Camp 2026 Registration

Camper's Information

Parent / Guardian Information

Medical Information

Parent & Camper Agreements