2026 Spring Co-Ed Camp Enrolment

CAMPER/CAREGIVER INFORMATION

IMPORTANT NOTE: Only the camper's caregiver/legal guardian (or referral agency) is able to fill this enrolment
Camper's Name

First NameLast Name
Gender
School Year in 2026
Birth Date

DayMonthYear
Caregiver's Email
example@example.com
Caregiver's Phone Number
Camper's Email (if applicable)
example@example.com
Camper's Phone Number (if applicable)
Camper's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Photo of Camper for Identification at Camp

We require photographic identification when completing an enrolment for each camper
Cancelof
OR take photo here:
EMERGENCY CONTACTS

Please ensure we can quickly contact caregivers and emergency contacts during camp
Caregiver 1

This is the person the camper usually resides with.
Caregiver 1's Name

First NameLast Name
Relationship to Camper
Caregiver 1's Phone Number
Second Phone Number (if applicable)
Caregiver 2

This is usually the spouse or partner of caregiver 1 OR another person the camper may reside with at times.
Caregiver 2's Name

First NameLast Name
Relationship to Camper
Caregiver 2's Phone Number
Second Phone Number (if applicable)
Emergency Contact Information

It is important we have a DIFFERENT third person who will be contacted only if we are unsuccessful in our attempts to contact the parents/caregivers listed above.
Emergency Contact's Name

First NameLast Name
Relationship
Emergency Contact's Primary Phone Number
Secondary Phone Number (if applicable)

SWIMMING & TRANSPORT
Child's Swimming Ability

Some of our camps may include swimming and/or water based activities. It is important our staff know the level of swimming ability to safely plan these activities.
What is the camper's swimming ability, to the best of your knowledge?
Transport
How will the camper be arriving at camp?
Name of Bus Company
Location of Pick Up
Arrival Time

MonthDayYear
Date
Hour MinutesAM/PM Option
Name of Bus Company
Location of Drop Off
Departure Time

MonthDayYear
Date
Hour MinutesAM/PM Option
People Authorised to Collect Camper - If this changes, you MUST email/text CYC with new authorised collector
It is important we know who is and is NOT allowed to collect your child at the end of camp. This person will need to sign your child out.

BEHAVIOURAL INFORMATION
Notification of Camper Background / Potential Struggles
- It is very important that our camp staff have a comprehensive understanding of each camper's background. We use this information to ensure suitable leadership and an appropriate response to certain issues.
- This information is kept confidential and will only be shared with necessary leadership.
Examples of a Behavioural Information List:

Bullying:
- John can sometimes bully other children.
- This relates to him being bullied as a younger child by older siblings.
- A clear reminder at the start of camp from leaders or the camp director about expectations around respectful behaviour would help John understand that bullying is not tolerated.
- A phone call to parents at the end of Day 1 may be used if needed to ensure consistency of support.
Struggles at home:
- Amy’s parents have recently separated, and she is struggling with this change. She may be more prone to emotional responses or acting out as a result.
Inattention:
- John can sometimes struggle to focus during group instructions. Support such as a leader being nearby to help reinforce instructions may be beneficial.
Please list all relevant/necessary background and behavioural information:
Does the camper have any behavioural issues, or any previous/current struggles that may present at camp?
Other Enrolment Information
Other Enrolment Information or Comments - Include any additional information relevant to your camper’s enrolment
Please note: Cabin requests cannot be changed within 7 days of camp start date.
Important note: if there is a parenting order, protection order, or other court order/agreement, please submit a copy of this order to CYC Waihola so a safety plan can be discussed with you and generated.
How did you hear about this camp?

Other
Which school does the camper attend?
If you attend a church, please write which one below

Should be Empty:

Rows	Medication Name (e.g. Melatonin)	When Needed (e.g. Evening)	Dose (e.g. 1 x 2mg tab)	Reason (e.g. Needed for sleep)
Medication 1
Medication 2
Medication 3
Medication 4
Medication 5
Medication 6
Medication 7
Medication 8
Medication 9
Medication 10

CAMPER/CAREGIVER INFORMATION

EMERGENCY CONTACTS

SWIMMING & TRANSPORT

MEDICATION INFORMATION

MEDICATION DOSAGE CHART

BEHAVIOURAL INFORMATION