SBC | LIT Session Registration – Maple Springs Bible Camp

Both the L.I.T. and parent will need to fill out portions of this form. Please make sure both members are available to fill out their part of the form.

Camper's Name *

First

Last

Birth Sex *

Male
Female

Comment

Birthday *

Age (at the start of camp) *

Mailing Address *

Address Line 1

City

State / Province / Region

Postal Code

Guardian's Primary Phone # *

Guardian's Secondary Phone #

ex. Home phone or another guardian's number

Email *

Email

Confirm Email

LIT's Email

Email

Confirm Email

Does your camper attend church? *

Yes
No

New To Maple Springs? *

Yes
No

Guardian Name *

First

Last

Guardian Name

First

Last

Guardian Signature *

Clear Signature

Medical Infomation

Care Card Number *

Doctor's Name

Doctor's Phone #

Alternate Contact Name *

First

Last

Someone other than the camper's guardian(s)

Relation To Camper *

Alternate Contact # *

Any Allergies? (other than food) *

Yes
No

Special Dietary Needs? *

Yes
No

Will the camper be bringing any medication or supplements to camp? *

Yes
No

We provide children's acetaminophen, ibuprofen and allergy medication if needed. Any medication brought (including vitamins & melatonin) must be handed over to our 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.

*New this year: If you are bringing medication, please be prepared with a list that includes: medication name, description, and dosage OR bring medications in original packaging.

Any Diagnosis or Notable Behaviours?

Yes
No

Ex. ADHD, Cerebral Palsy, Concussions, Autism, Diabetes, PTSD, Developmental Delays, Etc.

Any Extra Supervision Needs? *

Yes
No

Are there any reasons the camper may need extra assistance? Are there reasons that during activities (including water sports) in which the camper cannot participate, due to health or disability?

Anything else to note?

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. Participation in activities 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. 2. 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. 3.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. 4. 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. Participation in inflatable devices and other activities (such as: archery, pelletry, hiking, 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 all spaces used by the ministry point. 5. 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, and sign it freely and voluntarily. *

Yes, I have read the above information

L.I.T.'s Signature *

Clear Signature

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 *

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.

The following questions are to be answered by the LIT

Please answer fully

Why do you want to be an L.I.T this year? *

How will you contribute to the LIT program? *

Do you have any health concerns? *

If you are a Christian, briefly explain your spiritual journey and what it means to be a Christian *

If you are not a Christian, please enter "N/A"

What has God been teaching you over this past year? *

If you are not a Christian, please enter "N/A"

Is there anything specific you would like to learn about this week? *

Please explain any use (or involvement) in occult activity, inappropriate sexual behavior, tobacco, alcohol, non-prescription drugs, or self harm in the past year. Explain your belief or attitude regarding each of these items. *

Spring Break LIT Session *

Price: $165.00

Tuck (candy) Included

Optional Purchases

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

By clicking "Next" you will be taken to the payment page. A spot in the camp will not be secured until payment is made. Please contact registration@maplesprings.ca if you have an issue with the payment.

Select Paypal Checkout or Credit Card *

Card Number

Expiration Date

Security Code

Cardholder/Payer's Name *

First

Last

If paying with credit card, and cardholder's information is not the same as provided above, please fill out the following for accurate receipting:

(Skip this step if using Paypal Checkout)

Billing Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Cardholder's Email