Camper Registration Form

Child Name

First NameLast Name

Date of Birth

Date

Gender

Age at Camp

Former Camper?

Cabin/Team Mate (Campers must request each other)

First NameLast Name

Home Reserve

Leave blank if not applicable

Parent/Guardian Full Name

First NameLast Name

Parent/Guardian Phone Number

Area CodePhone Number

Parent/Guardian Email Address

Confirmation Emailexample@example.com

Home Address

Street Address

Street Address Line 2

CityProvincePostal CodeCountry

Emergency Contact Name

First NameLast Name

Emergency Contact Phone Number

Area CodePhone Number

Emergency Contact Email

Confirmation Emailexample@example.com

Relationship to Camper

Are there any court orders or custody restrictions which would prevent us from communicating with either parent/guardian?

Please provide information regarding court orders or custody restrictions with a parent/guardian. (We will contact you for additional information)

OHIP Number

Doctor Name

First NameLast Name

Doctor Phone

Area CodePhone Number

Does the camper have any FOOD allergies/intolerances? Please list. If any are anaphylactic please indicate that.

If there are no concerns please leave blank.

Does the camper have any other alergies? (bees, environmental, etc.) Please list.

If there are no concerns please leave blank.

Does the camper have an Epi-Pen?

Does the camper have an inhaler/puffer?

Medications the camper takes throughout the year:

Please bring Epi-Pens, puffers, and all prescribed medications to turn into the camp nurse at registration in their correct packaging. The nurse cannot dispense loose pills without the box or bottle with prescription information.

Date of Tetanus Shot

Date

Can over the counter medications be administered to the camper as needed, with direction from the camp nurse? Over the counter medications include, but are not limited to, Acetaminophen/Tylenol, Advil/Ibuprofen, Benadryl/diphenhydramine, antibiotic ointment, hydrocortisone cream, and aloe vera

Other

Is the camper under any form of treatment for illness, condition, or injury?

Please provide more information regarding treatment for illness, condition, or injury.

Does the camper have any medical or behavioral conditions that we should be aware of?

Please explain the medical or behavioral conditions.

Does the camper have an Educational Assistant, an IEP, or any special accommodations at school?

Please provide more information regarding the camper's Educational Assistant, IEP, or special accommodations at school.

Other known conditions

Important Notice: Please Read

Following submissions of the Camper Registration Form, 3 emails will be sent to the email address listed for the parent or guardian: a Parental Waiver and Release, a health form for a lice check, and a packing list for Bible camp.

Parental Waiver and Release

You will be receiving an email that includes the Parental Waiver and Release. This must be submitted before camp.

Lice and Nit Check

As a result of our commitment to camper health and safety, Waasayaa North Bible Camp adheres to all requirements of the Thunder Bay District Health Unit (TBDHU). We require each camper to have a lice and nit check done by a medical professional within a week of attending camp.

You will be receiving a form that must be signed by a medical professional signifying that the camper does not have any lice or nits before attending camp. We recommend scheduling an appointment at your local clinic in advance.

If campers are found with lice or nits, they will not be able to attend camp. They will receive a full refund upon informing the camp.

Payment Information

The cost of camp is $400 per camper.

The easiest way to pay for camp is by Interac eTransfer. Just send your payment to cbcbeardmore@gmail.com for immediate deposit. Please include a note of your camper's name(s) to help us connect your payment with your camper.

We don't want the cost to prevent anyone from experiencing an incredible week at WNBC. Please email us at breehoff@wnbc.ca if you have questions about pricing.

If your reserve is helping cover the cost of your camper, please email us and inform us of the details and who we should be communicating with to ensure the payment is completed.

Conditions of Enrollment

By signing or submitting this registration, the parent or guardian acknowledges and agrees as follows:

1. Waasayaa North Bible Camp is a Christian ministry of the Community Baptist Church of Beardmore and teaches Christian values and lessons from the Bible.

2. Camp activities may involve inherent risks, including but not limited to outdoor recreation, water activities, and sports. The parent or guardian acknowledges these risks and voluntarily assumes them on behalf of the camper. While every precaution is taken for the safety and good health of campers, Waasayaa North Bible Camp, its directors, officers, staff members, members, employees, servants, agents, volunteers, and representatives are released and forever discharged from claims, costs, or actions of any nature arising from death, injury, harm to the camper, and property loss or damage, whether or not such loss is alleged to have been caused or contributed to by the negligence of the directors, officers, staff members, members, employees, servants, agents, volunteers, or representatives of Waasayaa North Bible Camp, Community Baptist Church of Beardmore, and its partnering ministries.

3. In the event of an emergency, every effort will be made to contact the parent or guardian. If the parent or guardian cannot be reached, permission is given to Waasayaa North Bible Camp to hospitalize the camper or secure proper treatment. All costs arising from emergency medical treatment, transportation, or hospitalization are the financial responsibility of the parent or guardian. The Camp is licensed and inspected in accordance with applicable Ontario law. A camp nurse is available to assist campers with health related issues. Medical treatment beyond first aid and care provided by the camp nurse remains the responsibility of the parent or guardian.

4. The Camp assigns cabins, bathrooms, and related facilities having regard to camper safety, privacy, supervision, the Camp’s religious character, and applicable legal obligations. If a camper or parent or guardian has a request relating to accommodation, privacy, gender identity, disability, medical needs, or any other protected ground under applicable human rights legislation, the request should be raised with the Camp in advance so that it can be considered on an individualized basis.

5. The Camp Director reserves the right to dismiss a camper who rejects or contravenes the reasonable guidelines of the Camp. If a camper is dismissed, the parent or guardian must retrieve the camper as soon as possible and in any event within 12 hours of being notified of the dismissal. Until the camper is retrieved, the Camp will provide basic supervision but shall have no liability beyond that of a reasonable custodian. The Camp is not responsible for any resulting inconvenience or disruption to the parent or guardian, including the need to make alternative childcare arrangements. No refund will be issued after dismissal, and a dismissed camper may not attend any remaining portion of the session for which the camper was registered.

6. All campers and, in the case of a minor, the parent or guardian assume liability for any damage to the property of Waasayaa North Bible Camp caused by the camper.

7. Personal information provided to Waasayaa North Bible Camp will be used for camp administration purposes and will not be shared with third parties, except as required by law, in the case of an emergency involving the camper, or as otherwise described in these Conditions of Enrollment.

8. The parent or guardian consents to photographs, video recordings, and other visual or audio recordings of the camper being taken during camp events. Such recordings are the property of Waasayaa North Bible Camp and may be used by the Camp for internal purposes and in promotional materials, including but not limited to the Camp's website, social media accounts, newsletters, and print publications, without further notice or compensation.

9. The parent or guardian agrees to be contacted by Waasayaa North Bible Camp at the email address provided regarding upcoming events and promotions. The parent or guardian may unsubscribe from such communications at any time by contacting the Camp.

Parent or Guardian Name

I have read and accept the conditions of enrollment.

Date

Signature

Camper Registration Form

Child Information

Parent/Guardian Information

Emergency Contact Information

Medical Information

Please bring Epi-Pens, puffers, and all prescribed medications to turn into the camp nurse at registration in their correct packaging. The nurse cannot dispense loose pills without the box or bottle with prescription information.