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Camper's Given Name
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Camper's Surname
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Camper's Gender
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Male
Female
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Camper's Birthdate mm/dd/yy
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Register for which camp(s)
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Leader in Training (ages 14 - 16) June 27 - July 2
Junior (ages 8 - 10) July 4 - 9
Intermediate (ages 11 - 13) July 11 - 16
Junior & Intermediate (ages 8 - 13) July 18 - 23
Senior (ages 14 - 16) July 24 - 29
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Camper's Health Card Number
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Camper's Doctor: Name and Phone #
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Is this camper immunized against tetanus?
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Yes
No
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Does this camper have any allergies? Please provide details:
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Medications & dosages this camper will require while at camp:
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I give permission to Camp staff for the administration of the following non-prescription medications to my child:
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Tylenol
Ibuprofen
Gravol
Benadryl
Calamine Lotion
Afterbite
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Parent 1 / Legal guardian Full Name:
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Parent 1 / Legal guardian Email Address:
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Parent 1 / Legal guardian mailing address:
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Parent 1 / Legal guardian day & evening phone numbers / area codes:
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Parent 2 / Alternate contact full name:
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Parent 2 / Alternate contact email address:
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Parent 2 / Alternate contact day & evening phone numbers / area codes:
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Is the camper susceptible to any of the following? Check all that apply:
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Colds
Strep Throat
Fear of the dark
Bedwetting
Fainting
Sunstroke
Hyperactivity
Sleepwalking
Asthma
Bronchitis
Motion sickness
Headaches
Nosebleeds
Emotional outbursts
Other (explain below)
None of the above
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Any other conditions or considerations that would limit this camper's participation?
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Any other information or requests (esp. Who may pick up this camper from camp)?
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I would like to receive Camp Grafton news via:
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Registration is only complete and acceptable when your payment has been received. A nonrefundable deposit of $50 CDN is required within 72 hours of sending the form. Your registration will be confirmed upon receipt of full payment. Tax benefit: Camp fees qualify as a child care expense for those who qualify for child care tax benefits. Camperships: Financial assistance is available. Apply as you normally would, but contact the registrar.
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Yes
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Release and Consent:
I, the parent or guardian of the camper named below, do hereby release and discharge the CAMP GRAFTON SOCIETY and all its members, employees, and volunteers, from all actions, causes of actions, claims, demands, and suits howsoever arising which I may hereafter have arising out of the attendance of my child at CAMP GRAFTON in accordance with this application and I hereby indemnify and save them harmless for any damages arising out of such actions, claims, demands, or suits.
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Yes
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By submitting this application, I acknowledge the element of risk involved in which my child participating in activities carried out at CAMP GRAFTON and declare that I am satisfied that all reasonable precautions will be taken by employees of the CAMP GRAFTON SOCIETY
to minimize such risks.
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I understand the above:
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I hereby declare that to the best of my knowledge my child is in good health and is not being treated for any medical condition(s) which would restrict his/her participation in
the physical activities to be conducted at CAMP GRAFTON except as stated below on this form. I further confirm that I will supply any medications, including pain killers or treatment for insect bites which my child may require, together with written instructions as to the use of such medications.
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I understand the above:
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I hereby consent to medical treatment on behalf of my child as determined by a physician(s) engaged by CAMP GRAFTON SOCIETY in the event that I cannot be contacted in an emergency.
I agree that pictures of my child at camp may be taken for promotional purposes, but understand that the pictures will not be identified with the child's name.
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I understand the above:
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Submitting this form electronically is equivalent to signing a paper form registration form with your signature.
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Yes
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