Clone of Clone of 2024 Summer Camp Detailed Registration Form

Summer Camp Registration

In order to provide an excellent experience for your children, we ask for a $50 registration fee to cover the cost of the program. This can be paid on the first day of camp at the registration desk in cash, you can also do so here electronically: givings@knoxwaterdown.ca
Join us for an unforgettable week of creativity and discovery! Explore our children’s garden and learn to grow your own food. Unleash your artistic talents with fun crafts and projects. Build something amazing with woodworking activities. Experiment with science and create tasty snacks from recipes. Hear inspiring Bible stories that show us what people can do when they unlock their imagination. Each day brings a new adventure in faith, fun, and learning. For kids in J.K. through grade 6. Don’t miss out—register today!
Camper Information
Camper's Name

First NameLast Name
Birth Date

MonthDayYear
Going into Grade: (Numbers only, for Kindergarten, enter "0")
Camper's Gender

MaleFemalePrefer not to say
Home Address

Street Address

Street Address Line 2

CityProvince

Postal
Parent/Guardian Information
Name

First NameLast Name
Home Number
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the camper prescribed any medications pertinent to the camp schedule? If yes, please explain any instructions (i.e. inhaler, or daily medication).
Is there anything else that we should be aware of?
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Knox Church, Waterdown during the selected camp. This includes a photo/video release for photos and videos taken by authorized camp volunteers for use by Knox Church, Waterdown in promotional material. Additionally, we create a video presentation for all parents to view at the end of camp.
Medical Release and Authorization

As Parent and/or Guardian of the named camper, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named camper. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to Knox Church, Waterdown including staff and adult volunteers to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
Date
Signature

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Summer Camp Registration

Camper Information