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
