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Epic Camp
July 21-26| Ages: 11 - 13
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1
Camper Information
2
Waiver
3
Parent Permission Form
4
Payment
Camper's Name
*
First
Last
Birth Sex
*
Male
Female
Comment
Birthday
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Age (at the start of camp)
*
Address
*
Address Line 1
City
State / Province / Region
Postal Code
Guardian's Primary Phone #
*
Guardian's Secondary Phone #
eg. Home Phone or another guardian's number
Email
*
Email
Confirm Email
Does your camper attend church?
*
Yes
No
Name Of Church (if any)
New To Maple Springs?
*
Yes
No
Cabin Mate Request (limit 1)
Please keep to one request. We will try our very best to make your request happen!
Guardian Name
*
First
Last
Guardian Name
First
Last
Guardian Signature
*
Clear Signature
Medical Infomation
Care Card Number
*
Doctor's Name
Doctor Phone #
Alternate Contact Name
*
First
Last
Someone other than the campers guardian(s)
Relation To Camper
*
Alternate Contact #
*
Any Allergies? (other than food)
*
Yes
No
Please explain
*
Special dietary needs?
*
Yes
No
Please note any allergies or intolerances
*
Someone from our food service team may reach out and ask for your help accommodating certain dietary needs (only if needed)
Any diagnosis or notable behaviors?
*
Yes
No
Ex. ADHD, Cerebral Palsy, Concussions, Autism, Diabetes, PTSD, Developmental Delays, Etc.
Please explain
*
Behaviors, trigger and strategies for success
Will your camper bringing any medication to camp?
*
Yes
No
We provide children's acetaminophen, ibuprofen and allergy medication if needed. Any medication brought (including vitamins) must be handed over to First Aid Attendants and will be given to your camper at the required times - exception to an EpiPen or inhaler that must stay on the camper at all times.
Please list and explain medication routines
*
You will be able to talk to our first aid attendant upon arrival in needed
Any sleeping, eating, or bathroom habits/routines or team should know to make your campers experience better?
*
Yes
No
Ex. may wet the bed, gets really hangry, reminders to drink water, night time fears, usually gets read a story, reminder to brush teeth, etc.
Please explain
*
Anything else to note to our team?
Anything not mentioned that you think may be helpful for us to know. i.e. swim confidence, something they are nervous about, etc.
Next
Informed Consent and Assumption of Risk Agreement
Participant's Name
*
First
Last
IN CONSIDERATION of being permitted to participate in any way at Maple Springs Bible Camp, (hereafter known as ministry point) operated by One Hope Ministries of Canada , I acknowledge, understand, and agree: 1. The COVID-19 virus pandemic remains an on-going threat. I understand that there still is a risk of exposure to the virus while my child attends the camp, in spite of the precautions that have been taken by the ministry point in following directions outlined by local health authorities to try to limit exposure to the COVID-19 virus or to other communicable diseases. I further understand if my child has a pre-existing condition, it may make them more vulnerable to the virus. 2. The ministry point program includes inflatable “bounce house” devices. The ministry point operates the inflatable devices with trained staff under supervision, and only as intended by the manufacturer. 3. Participation in inflatable devices and other activities (such as: archery, pelletry, hiking, trampoline, playground, swimming, etc.) could result in possible personal injury. Despite precautions taken by the ministry point, accidents and injuries may occur. By signing this form, I assume all risks related to the use of any and all spaces used by the ministry point. 4. To release from responsibility, the ministry point, including all missionaries, full-time and part-time, paid or volunteer, and the facilities used from any cause of action, claims, or demands now, and in the future that might arise out of the participant’s participation in activities at the ministry point or from the physical risks associated with the activities. 5. I accept all risks relating to such activities including personal injury such as: cuts, sprains, scrapes, bruises, fractures, broken bones, concussions, death, or any personal property damage/loss, which may occur on the camp premises. I understand these risks and will not hold the ministry point liable for any such injury. 6. Furthermore, I agree to obey all ministry point rules and take full responsibility for my behaviour in addition to any damage I may cause to the facilities utilized by the ministry point. I have read this Informed Consent and Assumption of Risk Agreement, fully understand its terms and the risks I am assuming by signing it, I sign it freely and voluntarily.
*
Yes, I have read the above information
Participants Name (if 13 years and older)
*
First
Last
Address
*
Address Line 1
City
State / Province / Region
Postal Code
For Participants of Minority Age (under 18 at the time of registration)
Guardian Signature
*
Clear Signature
This is to certify that I, as parent/guardian with legal responsibility for this participant, have read this Informed Consent and Assumption of Risk Agreement, fully understand its terms, and that I have given up substantial rights by signing it, and sign it freely and voluntarily.
Date
*
Guardians Phone #
*
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Parent/Guardian Permission Form - Please Read Prior To Registering
*Initial
*
Clear Signature
In case of emergency, I understand every effort will be made to contact me. In the event that I cannot be reached in an emergency situation, I hereby give permission to licensed emergency and health care personnel to provide treatment, services and transport necessary to maintain the health of my child. In the event medication, medical advice, treatment and/or equipment are required, I agree to accept financial responsibility for fees in excess of provincial and or private medical insurance. I agree that the information on this form may be disclosed to such emergency and health care personnel. In the event of illness, accident, emergency, or any other circumstance requiring medical treatment, such treatment may be procured for the participant without legal or financial obligation to Maple Springs Bible Camp and One Hope Canada. All known health issues of my child have been stated to the camp. I will notify the camp if my child is exposed to any infectious diseases prior to arriving at camp.
*Initial
*
Clear Signature
I agree to allow photographs or video of camp activities, which may include my child, to be used in any and all camp promotional material including the sharing of photographs and videos with ministry partners of One Hope Canada.
*Initial
*
Clear Signature
I have read and understood the terms of this agreement and BY ALLOWING MY CHILD(REN) to participate in the camp, I am voluntarily agreeing to abide by these terms. I confirm that the participant [my child] is physically and mentally able to participate in all activities of the camp, unless specifically indicated otherwise in writing.
*Initial
*
Clear Signature
Maple Springs Bible Camp reserves the right to request any participant to withdraw from their camp if the participant is not acting in an appropriate and responsible manner.
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Epic Camp
*
Price:
$ 260.00
Tuck (candy) Included
T-Shirt Size
*
Choose a Size
Youth 6/8
Youth 10/12
Youth 14/16
Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2XL
New this year: Every camper will get 1 free T-shirt this summer! Sizes are not guaranteed, but choosing a size will help us order as accurately as possible.
Optional Purchase
Donation
We greatly appreciate our cabin leaders and summer team. Here, you give a financial gift that will go towards the people making camp happen for your campers! Any donations above $50.00 will receive a donation tax receipt! Thank you so much for your support!!
Total
$ 0.00
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Complete!
