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2010 Summer Camp On-line Registration Form

To register, complete the registration form and click on submit at the bottom of the form.  This will then take you to the online payment section.  Online registration is for credit card or paypal only (full payment at the time of registration).  Please answer ALL questions on the registration form - incomplete forms may not be processed. 

Please complete a separate registration form for each child.   

***IMPORTANT***

This form must be completed by a parent/guardian.

Online registration is for credit card/paypal only and FULL payment is required at time of registration.
Please select a summer camp session(s): If Sessions FULL *call us to be added to waitlist

Please select age group:

Registration includes a free Camp Jubilee T-Shirt. Please select size:


CAMPER INFORMATION


Camper First Name:

Camper Last Name:

Gender:

Date of Birth:
(YYYY/MM/DD)

Age at camp:

Will your child have a birthday while at camp?

Street Address:

City:

Province:

Postal Code:

Home Phone #:

Email:

Full Name of Parent/Guardian #1

Daytime Phone # of Parent/Guardian #1

Evening Phone # of Parent/Guardian #1

Full Name of Parent/Guardian #2

Daytime Phone # of Parent/Guardian #2

Evening Phone # of Parent/Guardian #2

Name of other Emergency Contact Person (other than parent):

Daytime Phone # of Emergency Contact Person

Evening Phone # of Emergency Contact Person

Relationship of Emergency Contact to camper:

Custody:

Who is authorized to pick-up your child from camp?

What grade is child entering in September 2010?

Name of School:

Personal Health Number (Care Card#):

Doctor's Name:

Doctor's Phone #:


CAMPER EXPERIENCE & INTERESTS


Cabin Request: If possible, my child would like to be in the same cabin as (must be the same age group & gender):

Has your child been to Camp Jubilee before?

If so, when:

What are your child's sleeping habits?

If you choose 'other' to the previous question - please explain.

Does your child have any fears (i.e. water, dark, etc)?

What is your child's swimming level?

Is there anything your child is concerned with about going to camp?

What things would you like your child to accomplish at camp?

What things would your child like to accomplish at camp?


CONFIDENTIAL HEALTH INFORMATION


Are all your child's immunizations current?

Please list any medications being taken at camp and their specific directions for use (i.e. medication name, dosage, when administered, etc):

Please list any allergies your child may have as well as the severity and treatment:

Is your child under any treatment/medication for any condition or injury?

If yes, please explain:

Has your child been medicated for ADD/ADHD during the last 12 months?

Does your child have any behaviour/social challenges that require our attention or observation?

If yes, please explain:

Does your child have any special dietary requirements?

Please provide us with any information about your child that you feel will assist us.


How did you hear about us (i.e. friend, newspaper, school, camping bureau, etc)?


CAMPER & PARENT AGREEMENT - Read below


AUTHORIZATION - Read below


CAMPER & PARENT AGREEMENT - Both the parents and the camper have discussed the upcoming camp experience.  The camper understands and commits to fully participating in camp activities.  The camper will follow safety directions and refrain from behaviour which is harmful to themselves or others.  In addition, the parent understands and supports Camp Jubilee's policy that prohibits possession or use of tobacco, alcohol or non-prescription drugs and understands use of these substances or other abusive behaviour is cause for dismissal without refund of camp fees.

AUTHORIZATION - (NOTE: A "Participant Informed Consent Form" must also be completed and will be included in your Camp Confirmation Package) I/we grant permission for our child named above to take part in Camp Jubilee's Summer Camp and I/we agree to assume financial responsibility in case of injury or accident arising out of such event.  In case of injury or illness, I/we authorize Camp Jubilee staff to administer treatment, and in such case, it is understood that Camp Jubilee is not responsible for medical costs.  Photo Release:  I/we give permission to use my child's photo in any Camp Jubilee newsletter or other related publication.

PRIVACY STATEMENT:  Camp Jubilee Retreat & Conference Centre and Indian Arm Management Services Ltd. respects your privacy.  We protect your personal information and adhere to all legislative requirements to protecting your privacy.  We do not rent, sell or trade our mailing lists.  We use your personal information to provide programs/services and to keep you informed and up-to-date on Camp Jubilee activities including programs, services, funding needs, volunteer opportunities or provide support through periodic communication.  If at any time you wish to be removed from any of these types of contact or receive a full copy of our privacy statement, please notify us by phone or in writing and we will gladly accommodate your request.
Operated by INDIAN ARM MANAGEMENT SERVICES LTD. In partnership with THE CHILDREN'S JUBILEE SUMMER CAMP ASSOCIATION
2706 Spring Street Port Moody, BC V3H 0G1 tel#: 604.937.7388 fax#: 937.7322 e: info@campjubilee.ca

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