Online Registration

Which Camp are you Registering for?
Cold Snap - Winter 2012Deep Freeze - Winter 2012Grades 2&3 - Summer 2012Grades 4&5 - Summer 2012Grades 6&7 - Summer 2012Grades 8&9 - Summer 2012High School - Summer 201255 + - Summer 2012Family Camp - Summer 2012

First Name

Last Name

Mailing Address

City

Province/State

PostalCode/Zip

Email Address

Current Age

Date of Birth
(Day/Month/Year)
Gender
M F 
T-Shirt Size
Youth-SmallYouth-MediumYouth-LargeYouth-XLAdult-SmallAdult-MediumAdult-LargeAdult-XL

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)

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 any medication the camper may be taking, as well as details concerning dosage and application as prescribed: (Separate medical detail forms available upon registration)

Does your child have any sleeping disorders? (i.e: bedwetting or sleepwalking) If so, please describe them so the staff may prepare for handling incidents that may otherwise prove embarrassing for your child:

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.