Online Registration

Please be sure to fill out all the necessary information below. 

Which Camp are you Registering for?

First Name

Last Name

Mailing Address

City

Province/State

PostalCode/Zip

Email Address

Current Age

Date of Birth
(Day/Month/Year)
Gender
M F 

Parents/Guardians
(separate by commas)

Home Phone

Work Phone

Other (cell)

Is there a joint Custody Arrangement?
Y N 

Note: If anyone other than the parent/guardian indicated above will be picking up the camper, we must receive written notification by noon one day before the end of the camp in question.

Emergency Contact Name

Emergency Contact Phone

Does the camper attend church?
Y N 
If Yes, Church Name

Church Location

Church Phone

Minister/Pastor

If you and a friend want to be assigned to the same room, we’ll try to accommodate your wishes.
Name of room mate (one only)

Have you been to Canoe Cove Christian Camp before?
Y N 
If NO, who asked you to come to camp?

Prov. / Health Insurance Care Card #

Name of Family Doctor

Doctor's Phone

List of Allergies

Physical conditions that may hinder full participation in the Camp program

We require a detailed list of ALL medication the camper may be taking, as well as details concerning dosage and application as prescribed: (Separate medical detail forms available upon registration)

Has your child had any of the following vaccinations:
- MMR (Measles, Mumps, Rubella)
Y N 
- Tetanus/Diphtheria
Y N 
- H1N1
Y N 

You must indicate if your child is permitted to have the following medications, should the child get a headache, allergic reaction or stomach ache. If you do not indicate "Yes", your child will not have these medications administered.
- Headache: Acetaminophen (Tylenol)
Y N 
- Headache: Ibuprofen (Advil)
Y N 
- Stomach: Antacid Tablet (Tums)
Y N 
- Stomach: Gravol or Pepto-Bismol
Y N 
- Antihistamine (Benadryl)
Y N 
- Topical creams or liquid drops (sunscreen, polysporin, eye drops, Aloe Vera, etc.)
Y N 

Note: All medication that is to be dispensed during a campers stay at Canoe Cove Christian Camp must be handed in to the Nurse/Medical personnel or to a designated adult during sign-in, and will be administered to the applicant camper per instructions. All medications will be locked up and given at the appropriate times for each day at the Medical Station. Each camper is required to have the medications in their original packaging or in a blister pack (talk to your pharmacist or doctor about these packs).

Medical Waiver: This waiver gives authority to Canoe Cove Christian Camp, Inc., or to a designated adult, to arrange for Medical / First Aid care for a minor in the event of an emergency while attending Canoe Cove Christian Camp.
Parent/Guardian's name:

Additional Comments

***By clicking the SEND button below I hereby approve and confirm his or her participation, and release Canoe Cove Christian Camp Inc., its Directors, the management, staff, agents, employees, or any persons associated with Canoe Cove Christian Camp Inc., from any claim or action for any injury or injuries that may be received by the said child while attending Canoe Cove Christian Camp, and/or any normal camp activities associated with Canoe Cove Christian Camp including those off of the property of Canoe Cove Christian Camp.
I agree to permit the reasonable use of photos and videos or other pictures of applicant camper in promoting the camp or camp activities or programs.

The Camp's main telephone number is (902) 675-3039. Feel free to write to us at: Canoe Cove Christian Camp P.O. Box 661 Charlottetown, PE C1A 7L3 Canada We look forward to hearing from you.

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