St Paul's
October-21-17


2017
Vacation Bible Camp
Registration Form

LOCATION:  St. Paul’s United Church
308 King Street, Midland

DATE: July 31 to August 4 (9-12 noon)


NAME:  _______________________________________________________________
 
ADDRESS: ____________________________________________________________
        (Street or PO Box)
    ______________________________________________    ________________   
        (City or Town)                        (Postal Code)

HOME PHONE: ____________________                 AGE:  ________________

PREFERRED EMAIL ADDRESS: ___________________________________________


IN AN EMERGENCY PLEASE CONTACT:    


     ________________________________________________________________
         (Name and Relationship)               

HOME/CELL PHONE: ____________________________________________________

OFFICE PHONE:     _____________________________________________________

EMAIL ADDRESS:      _____________________________________________________

                           


ACCESSIBILITY

Do you have special requirements (e.g. handicapped parking, wheelchair ramps, sign language)?

Please specify ___________________________________________________________



DIETARY INFORMATION
PLEASE NOTE ANY DIETARY CONCERNS/RESTRICTIONS:
    _________________________________________________________________

    _________________________________________________________________


MEDICAL INFORMATION

Health Card #____________________________

Campers are responsible for administering their own prescribed medication as well as informing leadership when they take it for their own safety.  Please include a description of possible side effects and the appropriate medical treatment.

Medical Information: ______________________________________________________

    _________________________________________________________________


ARRIVAL AND DEPARTURE

CAMP AWESOME begins at (9:00na.m.).  Campers may arrive between (8:30 a.m.) and (9:00 a.m.).  Camp finishes at (12 noon) and campers MUST be picked up by (12:15 p.m.).


Who is authorized to pick up this camper at the end of the day?

__________________________________________________________________________

Pick-up Person’s Phone Contact:

__________________________________________________________________________


PLEASE NOTE THAT WE WILL REQUIRE ACCURATE INFORMATION AS TO WHO IS AUTHORIZED TO PICK UP CAMPERS.

IF EMERGENCY INFO AND/OR PICK-UP INFORMATION CHANGES DURING CAMP, PLEASE NOTIFY THE CHURCH OFFICE AT: St. Paul’s United Church  705-526-6077