Kamp Inn 2019 - Registration Form
All participants must be in Grades 3-8.
Last Name *
Your answer
First Name *
Your answer
Date of Birth *
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DD
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Gender *
Age *
Your answer
Grade in School *
Your answer
Parent/Legal Guardian Name *
Your answer
Parent/Legal Guardian (2)
Your answer
Parent/Guardian Email Address *
Your answer
Additional Email Address
Your answer
Phone *
Best number at which to reach you
Your answer
Additional Phone Number
Your answer
Home Church
If applicable
Your answer
T-Shirt Size *
Medical and Emergency Information
Does the camper have allergies? *
If yes, please list all known allergies and their severity
Your answer
Is the camper bringing any medication? *
Please inform our camp nurse during registration
If yes, what medications will he or she be bringing?
Your answer
Does the camper have any physical, emotional, mental or behavioural issues that our leadership should be aware of? *
If yes, please explain.
Please also review the needs of your child with Matt, the camp director.
Your answer
Emergency Contact Name *
Your answer
Relationship to camper *
Your answer
Emergency Contact Number *
Your answer
Ontario Health Card Number *
Your child must be covered by Provincial Health Insurance or equivalent medical insurance.
Your answer
Liability and Photo Release
I agree to leave my child in the care of Glen Acres' staff and volunteers. I agree to allow them to take emergency measures on my behalf for the duration of Kamp Inn. In the event of accidental injury or illness, I release Glen Acres Baptist Church, its staff, and its volunteers from any liability. I agree to allow Glen Acres Baptist Church to use still or video photos of my child in church publications or in slide or video.
Do you agree to these terms and conditions? *
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