Name of Camper
*
First Name
Last Name
M/F
*
Date of Birth
*
MM
DD
YYYY
Grade this Fall
Address
*
Please include full mailing address.
Home Phone
*
(###)
###
####
Camper Email
Parent Email
*
Who will bring the camper to & from camp?
*
Are you a first time camper at Mount Forest Camp?
*
Do you need skates? If yes, what size?
*
The Camper's Promise
*
As a camper at Mount Forest Camp, I fully accept my responsibility to respect Camp rules, fellow campers, camp property, and the authority of Camp leaders and staff. In particular, I understand and will comply with the requirement that the following are not allowed at Camp: weapons, electronic entertainment devices (including cell phones), tobacco & vaping products, drugs or alcohol, or any other device or substance that in the Leader’s opinion may injure or otherwise adversely affect my own, or anyone else’s, benefit or enjoyment of the programs at Mount Forest Camp.
Parent/Guardian #1
*
Name, Address, Relation to Camper, Home Phone & Cell Phone Number
Parent/Guardian #2 or Emergency Contact
Name, Address, Relation to Camper, Home Phone & Cell Phone Number
Release
*
I hereby authorize the camper referred to on this form to attend and participate in the Camp indicated on the reverse. I release the Churches of God, Camp Directors, Session Leaders, and staff from all responsibility and liability in connection with any harm which may occur to this camper however caused while at or in transit to or from the Camp. I will promptly advise Camp leaders should this camper develop a harmful communicable disease, or other health problem likely to adversely affect other campers attending Camp. I accept that part of the enjoyment of the normal Camp program relates to the camper participating in risk-taking activities, and such participation does not involve gross or willful negligence by those responsible for the camper. I authorize and accept the risks of the camper being transported to and from camp for off-site components of the camp program in the personal vehicles of the staff, and accept that the camp will attempt to provide the same standard of care for offsite activities as those at the camp site. In the event the camper requires medical attention (including first aid and emergency hospital care) I authorize Camp Session Leaders to act on my behalf to ensure immediate treatment for him/her. I support the Camper’s Promise, and if required I will arrange for pick up from the Camp if Directors determine the camper should leave the Camp. Further, I authorize the person named above to pick up the camper from Camp. I permit the Camp to use audio/video/photographic materials which include the camper in promotional materials or other uses authorized by Camp Directors. I have read this form in full, and accept full responsibility for this camper.
Doctor's Name
*
Doctor's Phone Number
*
(###)
###
####
Emergency Contact
*
Emergency Contact's Phone Number
(###)
###
####
Allergies
*
Participant is allergic to: (list any foods, medication, insect stings, environmental allergies)
Allergy Release
*
I accept:
1. MY CAMPER’S REGISTRATION ACCEPTANCE WILL ONLY BE FINAL AFTER DIETARY NEEDS ARE REVIEWED, DISCUSSED (WITH PARENT/GUARDIAN) AND ACCEPTED IN WRITING BY CAMP KITCHEN STAFF AND LEADERS WHO CAN ACCOMMODATE A VERY LIMITED NUMBER OF CAMPERS WITH SPECIAL DIETARY NEEDS. A CANCELLATION AND REFUND WILL BE GIVEN IF CAMP IS UNABLE TO ACCOMMODATE THOSE NEEDS.
2. Camp is not an allergen-free environment and cannot provide assurance there will be no exposure to the camper to new or previously identified allergens.
Does this participant carry an EPI-PEN?
*
Expiry Date of EPI-PEN
When was EPI-PEN last used?
Where is EPI-PEN usually kept?
Please describe participant‘s allergy REACTION/SIGNS
Please include any additional allergy information.
Date of last TETANUS SHOT
Participant has the following MEDICAL CONDITION and SYMPTOMS
Please include any prescribed medications.
Participant has the following RESTRICTIONS
Please describe participant’s medical condition REACTION/SIGNS
Agreement
*
By completing this form, all relevant health and medical information for the listed participant has been communicated to Mount Forest Camp. NOTE: Information disclosed on this form may be communicated to the appropriate camp staff at the discretion of the Head First Aid Officer.
