Camp Keir Retreat Registrations
Email *
Phone Number *
Guardian Name *
Camper Name *
Age of Camper *
Signing Up for Which Retreat *
Required
Grade of Camper *
Date of Birth *
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Mailing Address *
Campers Gender *
Campers Health Card Number *
Health Card Expiry Date *
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Name of Family Doctor and their Phone Number *
In case of emergency, and we are unable to reach parent/guardian listed above, please list 2 DIFFERENT people that we may notify. Please include their contact information: *
Does the camper have any of the following allergies: *
Required
If you checked any of the following allergies, please specify so we can accommodate the camper accordingly.
If you checked any allergies above, does your camper carry an epipen?
Clear selection
Is your camper susceptible to any of the following: *
Required
If you checked any of the boxes above, please specify.
Does your camper have any medical condition we should be aware of? *
Does your camper require any special diet? If so, what? *
Has your camper had any serious illness in the past year? *
Date of last Tetanus Booster (must be up to date)
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Does your camper have any medical or physical restrictions? *
Is your child bringing any medication (Prescription or over the counter) to camp? If "Yes", all medication is put in the care of the Camp Director. *
If so, please name any medication and SPECIFY the use, dosage, and time your child normally takes it.
I give the Camp Keir Director permission to give my child normal doses of over the counter medication. (Tylenol, Advil, Benadryl, and/or Gravol) as deemed necessary. *
I hereby give permission to Camp Keir to secure emergency medical/surgical treatment and routine non-surgical medical care. (Perform First Aid as necessary) *
Who may pick up your camper from camp? PLEASE BE SPECIFIC and give EVERY NAME *
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 form 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 appear to have rejected the reasonable controls of the camp. *
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. *
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. *
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