Welcome to the Summer of 2018!
Registration and Waiver Form
Preferred Camp (s) *
Required
Preferred Day Camp Session(s)- Including CIT, LIT & Junior Guides *
Required
If you are attending Day Camp - would you like to try an overnight camp out
Preferred Voyageur Camp(s) or Science Camp- Including CIT, LIT & Junior Guides
Preferred Canoe Trippers Camp(s) - Including CIT, LIT & Junior Guides
Leaders-in-Training Program Options
Camper's Name *
Your answer
Camper's Birthdate *
Your answer
Parent's Name (s) *
Your answer
Primary Phone Number *
Your answer
E-mail Address *
Your answer
Dietary Requirements *
Anaphylactic Allergies *
Does your child carry an epi-pen or have a serious medical allergy?
Medical History *
Please describe any relevant information in regards to your child's physical health - or answer n/a for non-applicable.
Your answer
Emotional, Social and Mental Health History *
Please describe any information that might be helpful regarding anxiety, depression, ADHD, OCD, ASD, Aspergers, OCD and any other relevant information - or answer n/a for non-applicable.
Your answer
Any Other Important Information?
Is there any additional information about your child that you wish to share. For example: difficult home/school situations, bullying, care of braces/contacts, shyness, home sickness, special procedures that are to be used at the camp. Please be as thorough as you can. It is the parents’/guardians’ responsibility to inform the camp of any emotional, physical, physiological, social or medical challenges faced by the camper that may have an impact upon their camp experience. If you feel that any of these items require further discussion with the camp, please contact the Directors at any time.
Your answer
Emergency Contact & Phone Number *
Your answer
Family Doctors Name & Phone Number *
Your answer
Do you give us permission to contact the Doctor if necessary? *
Do you give us permission to administer age appropriate over-the-counter medication?
Health Card # *
Your answer
Is your child's immunization record up to date *
Can your child independently swim without the aid of a flotation device? *
Do you agree to the Booking Conditions as listed below *
Payments: For individuals full payment is due upon booking. If booking multiple dates, programs or participants - payment plans may be set up on an individual basis. For Payments over $300 - partial payments are acceptable with 50% at time of booking & 50% prior to program. Cancellations & Refunds: Full refunds are available when cancelling more than 30 days prior to the first day of a program minus a $50 administration fee. 50% refunds are available when cancelling between 14 and 30 days prior to the first day of a program minus a $50 administration fee. No refunds are available when cancelling less than 14 days prior to the first day of a program. Registrations are non-transferable. Thanks for your support and understanding.
Transportation *
Required
Please provide information regarding who is allowed to pick-up your child from camp or from the camp transportation shuttle. *
Your answer
Would you like to subscribe to our e-newsletter for up-coming events and information? *
Required
Do you agree to the Participation Waiver and Medical Consent information listed below? *
Great Moose Adventures reserves the right to suspend clients from activities, programs or performances where their behaviour is deemed unacceptable.Great Moose Adventures cannot be held responsible for the loss, theft or damage of belongings.Great Moose Adventures reserves the right to use photographs/video material of the clients and material created for promotional purposes such as web site, brochures and displays. All films, projects, music, songs, artwork etc. created at Great Moose Adventures may be used by Great Moose Adventures for promotional or educational purposes.By agreeing to these Terms & Conditions the parent or guardian of a child attending a Great Moose Adventures day program fully understands that such a program involves outdoor and indoor physical activities during variable weather conditions and that there are health and safety risks associated with these types of activities.By agreeing to these Terms & Conditions the parent or guardian, their heirs and assigns waive, release and absolve and agree to indemnify and save harmless Great Moose Adventures and their respective directors, officers, employees and agents from all liability arising from attendance and participation in a Great Moose Adventures day program.By agreeing to these Terms & Conditions the parent or guardian affirms that they fully understand the preceding paragraphs and volunteer their child to participate at their own risk.
Parent's Name
Your answer
Date
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