1. Please complete the form below.2. Print this page (File: Print, or click the button at the bottom of the form3. Mail your printed registration form and registration fee to:
CAMPER'S FIRST NAME :
LAST NAME:
ADDRESS:
TOWN/CITY:
PROVINCE:
POSTAL CODE:
EMAIL:
AGE:
SCHOOL:
HEALTH CARD # :
IS HE/SHE AWARE? :
GIVE DETAILS OF ALLERGIES, MEDICATIONS AND/OR HEALTH RELATED INFORMATION:
FAMILY DOCTOR:
PARENT/GUARDIAN NAME:
MY CHILD WILL BE TAKING THE BUS TO CAMP YES NO FROM CAMP YES NO IN CASE OF INJURY OR ILLNESS AT CAMP BICKELL, I GRANT PERMISSION TO CAMP PERSONNEL TO TAKE MY CHILD TO HOSPITAL TO RECEIVE MEDICAL TREATMENT:
Signature required on printed form:
I AUTHORIZE CAMP BICKELL TO PUBLISH MY CHILD'S PICTURES ON THE CAMPS WEB SITE:
PLEASE SELECT ONE OF THE FOLLOWING CAMPING DATES:
1st CAMP - June 23 to June 29 - Jr. Camp for Ages 7 to 11 2nd CAMP - June 30 to July 6 - Open Camp for Ages 7 to 14 3rd CAMP - July 7 to July 13 - Open Camp for Ages 7 to 14 4th CAMP - July 14 to July 20 - Open Camp for Ages 7 to 14 5th CAMP - July 21 to July 27 - Open Camp for Ages 11 to 14