2012 camp registration form ver2

If possible, please register online at www.salemacres.ca. Otherwise, please complete and mail in this form. Which summer 2012 camp are you registering for (Check one)?
Boys Adventure Camp (July 29 to August 3) Camper Information
parent/guardian is responsible for ensuring that the appropriate medication is sent with the camper. City: _____________ Province: ____ Postal Code: Unless directed otherwise, dosage of the above medicines will Birthdate (year/month/day): ________ __________ _______ be dispensed as per the directions on the package. Please indicate here if you prefer a different dosage. 5. Are immunization (e.g., tetanus) up to date? Any additional information you would like to share regarding Have you attended a SABC camp before? Yes No 6. Is there any history of disease (e.g., Hepatitis C)? Yes No Parent/Guardian Information
If yes, please send all appropriate medication with the camper. 5. Is there any other information that we need to know about the If contact information the same as camper, skip next section Fees: $150/camper
$140/camper to families sending three or more children City: _____________ Province: ____ Postal Code: to our camps if registering before April 15. Costs of a t-shirt and lifejacket are included in the camp fee. You are welcome to bring your own lifejacket, but the fee The above fee only covers the cost of the camper for the week. Emergency Contact Information
SABC appreciates any donation given to help offset our costs In case of an emergency, the person we should contact if the for running camps and/or as scholarships. By signing this registration and sending the camper to SABC, you 1. Medical - You give Salem Acres Bible Camp (SABC) and its
Medical Information (Use back side if necessary)
staff members the permission to proceed with emergency medical 1. Will the camper be taking any medication while at camp? treatment in the event we cannot contact you in the time Yes No If yes, please list the medication, dosage and available. We may authorize medical personnel to proceed with 2. Liability - You will not hold SABC, its staff members or
2. Does the camper have any allergies or has the camper ever volunteers liable for any accident in which loss or damages may reacted to any animals, foods, medications, environmental occur. You waive the right to proceed with any and all actions against SABC, its staff and volunteers for any incident, including If yes, please describe the reaction and how you treat the allergies at home? Do you give antihistamines? If so, how 3. Use of Photos – You give SABC permission to use photos
taken during camp by SABC staff and volunteers for promotional 3. Does the camper have any type of disability (mental, emotional or physical) that could affect his/her degree of participation in any activity? Yes No If yes, please describe. Parent/Guardian (or Camper if 18 or older) Consent 4. Can the camper take the following medications? If any medication is taken on a semi-regular basis, the Mail completed registration form with payment to: Salem Acres Bible Camp, P.O. Box 84129, Market Mall RPO, Calgary, AB, T3A 5C4
Any questions? More information? Contact us: Phone: (403) 773-2226, E-mail: [email protected], Visit us at www.salemacres.ca

Source: http://www.salemacres.ca/pdfs/2012campRegistrationForm.pdf