Welcome to the Summer of 2019!
Registration and Waiver Form
Preferred Camp (s) *
Required
Camper's Name *
Your answer
Camper's Age on the first day of camp - must be 4 yrs old *
Your answer
Camper's Gender *
Parent's Name (s) *
Your answer
Primary Phone Number *
Your answer
E-mail Address *
Your answer
Transportation *
Required
Anaphylactic Allergies *
Does your child carry an epi-pen or have a serious medical allergy?
Dietary Requirements *
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
Day Camp Preferred Session(s)
Voyageur Camp(s) Preferred Session (s)
Canoe Trippers Camp(s) Preferred Sessions
Super LIT = 1 canoe trip (session 2) + 1 Voyageur + 1 Day Camp. Please check your preferred weeks. We will contact you to determine the specifics.
1 Week LIT - please list the week and program and we will contact you.
Your answer
If you have chosen Day Camp - are you interested in an overnight campout? *
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? *
Has your child been stung by a bee or wasp? If not, our policy is to administer children's benadryl if/when they are stung for the first time as a precaution to a severe reaction. Do you agree to this? *
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 following Booking Conditions: A $275 deposit must be paid at time of booking to confirm your space. All remaining money owed must be paid by June 1st. Full refund if you cancel before June 1st - minus a $50 administration fee. 50% refund if you cancel in the month of June - minus a $50 administration fee. No refunds after July 1st. For longtime clients and families registering multiple children for multiple weeks, payment plans can be set-up, but all money must be received by July 1st. Registrations are non-transferable *
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.
Payment Option *
To confirm your booking you will need to make a payment. Upon sending this registration to us, we will send you an e-mail with your cost breakdown - which will be useful for an e-transfer or cheque. If you wish to pay by credit card - you will need to return to the website and look for a red pay button. Is this all good? *
Submit
Never submit passwords through Google Forms.
This form was created inside of Great Moose Adventures. Report Abuse - Terms of Service