Music Camp Registration

All Saints Church Music Camp

Registration Package
Child Information
Name

First NameLast Name
Preferred Name or Nickname (if different from above)
Gender or preferred pronouns
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Grade for 2026/27 school year:
Parent/Guardian 1 (Primary Contact)
Name

First NameLast Name
Relationship to Child
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
- Name
  
  First NameLast Name
- Relationship to Child
- Home Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Cell Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Work Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Email
  example@example.com
- Address (if different)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Emergency Contact
- Name
  
  First NameLast Name
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Relationship to Child
- (in addition to the parents/guardians listed above)
  
  Children will only be released to authorized individuals.
- Name
  
  First NameLast Name
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Relationship to Child
- Name
  
  First NameLast Name
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Relationship to Child
- Name
  
  First NameLast Name
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Relationship to Child

Medical Information
Dietary Restrictions:
Allergies:
Does your child carry an EpiPen?
Can they use it themselves?
Medical Conditions
Physical limitations or accommodations needed
Medications
Does your child carry an inhaler?
Can they use it themselves?
Manitoba Health Number
Six digit #
Nine digit #

Medical Consent
Liability Waiver
Photo Consent: I give permission for my child to be photographed orrecorded, and for them to appear in camp photos/videos used for promotionalpurposes.
Off-Site Permission (Park Visits)
Sunscreen and Insect Repellent
Behaviour Expectations
Late pick-up Policy:
Declaration and Signature:

By signing here I confirm that the information above is accurate, and that I agree to the policies listed above.
Name

First NameLast Name
Signature
Should be Empty:

All Saints Church Music Camp

Parent/Guardian 1 (Primary Contact)

Emergency Contact

Medical Information

Manitoba Health Number