Camp Keir Summer Registration 2017
Email address
Camper's Name:
Your answer
Camper's Age
Your answer
Which camp are you registering for?
Camper's Date of Birth
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DD
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Camper's Gender
Camper T-Shirt Size
Camp Keir's Camper Covenant: "I will follow the rules set out by the staff at Camp Keir while I am attending camp. I understand that if I do not follow these rules I may be asked to leave." Please check below if you agree to these terms.
Required
Guardian's Name
Your answer
Mailing Address
Your answer
Home Telephone Number
Your answer
Work Telephone Number (if different than above)
Your answer
Home Church (if applicable)
Your answer
If you register before June 1, 2017, you get $25 off!f you bring a new camper to camp you will receive another $25 off your registration fee! Please list the name of the new camper you're bringing to camp with you (if applicable):
Your answer
Waiver & Conditions of Enrollment: The participant or the parent or guardian of the named participant under 18 on this form, release Camp Keir, staff and agents from any loss, personal injury, accident, misfortune, or damage to the named applicant on this form or his/her property, with the understanding that reasonable precautions shall be taken to ensure the health and safety of the named applicant on this form. Each participant must be covered by PEI Medicare or equivalent medical insurance.The Camp Director reserves the right to dismiss a participant who, in his/her opinion, is a hazard to the safety and rights of others, or who appears to have rejected the reasonable controls of the camp.
Required
Camper's Health Card Number
Your answer
Health Card Expiry Date
Your answer
Name of Family Doctor and Phone Number
Your answer
In case of emergency, and we are unable to reach parent/guardian listed above, please list 2 different people that we may notify, including contact information:
Your answer
Does the camper have any of the following allergies:
Required
If you checked any allergies above, please specify:
Your answer
If you checked any allergies above, does your camper carry an epipen?
Is your child susceptible to any of the following:
Does your camper have any medical condition we should be aware of?
Your answer
Does your camper require any special diet? If so, what?
Your answer
Does your camper:
If you checked any of the above, please explain:
Your answer
Has your camper had any serious illness in the past year?
Your answer
Date of last Tetanus booster (must be up to date)
MM
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DD
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YYYY
Does your camper have medical or physical restrictions?
Your answer
Is your child bringing medication (prescription or over the counter) to camp? If "Yes", all medication is put in the care of the Camp First Aid Person.
Please name medication and specify use and dosage and the time your child normally takes it.
Your answer
I give the Camp Keir First Aid Person permission to give my child normal doses of over the counter medication (Tylenol, Advil, Benadryl, &/or Gravol) as deemed necessary
I hereby give permission to Camp Keir to secure emergency medical/surgical treatment and routine non-surgical medical care
Who may pick up your camper from camp?
Your answer
Copyright and/or use photographic representations of my camper in various forms of media used by photographers and computer artists to assist the camp, including to use in publicity, promotion, camp advancement, marketing, and/or educational purposes, including the use of any printed or multi-media materials for Camp Keir.I hereby realize and accept that this is on a voluntary basis and no financial remuneration will be received from the photographer, Camp Keir or any firm publishing and/or distributing the finished product.I have read, understand and agree to this release.
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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