Registration Form

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Parent/Guardian: B y s igning b elow, y ou

acknowledge t hat:

REGISTRATION FORM

1.All r egistration f orms m ust b e

accompanied b y a $ 25 n on-‐refundable

Camper Name: ____________________________

deposit. C ampers a re r egistered w hen

cheque h as b een d eposited a nd c leared.

____________________________

Payment i n f ull i s d ue u pon a rrival o n

opening d ay o f y our c hild’s c amp.

Gender:

____________________________

2. A lthough e very e ffort i s m ade t o s end

Name(s) of parents _________________________

campers h ome w ith a ll o f t heir

or guardians:

belongings, C amp M acLeod i s n ot

_________________________

responsible f or a ny l oss o r d amage.

3. Y our c hild w ill f ollow a ll r easonable

Address (including _________________________

instructions f rom t he s taff o f C amp

Postal code):

MacLeod w hile p articipating i n t he

_________________________

program.

4. C amp M acLeod r eserves t he r ight t o

_________________________

cancel a c hild’s p articipation i n a c amp

Email Address: ____________________________

session i f t heir b ehavior i s d eemed

unmanageable o r d angerous t o

____________________________

themselves o r o thers, i n w hich c ase t hey

will b e s ent h ome i mmediately.

Phone Numbers: (1)________________________

5. Y ou r elease C amp M acLeod, i ts s taff,

volunteers a nd t he C ape B reton

(2)________________________________________

Presbytery o f a nd f rom a ll m anner o f

Date of Birth: ______________________________

actions, c laim a nd d emands o f w hatever

nature w hich r esult f rom a ny l oss, i njury

Age (as of July 1) ___________________________

or e xpense s ustained, a rising o ut o f o r i n

any w ay c onnected w ith p articipation i n

Health Card # ______________________________

any p rogram o r a ttendance a t a l ocation

operated b y C amp M acLeod.

______________________________

6. I n t he e vent y our c hild i s i njured, i ll o r

in n eed o f m edical a ttention a nd y ou a re

Home Church: _____________________________

unable t o b e c ontacted, y ou a uthorize

Clergy: ____________________________________

Camp M acLeod s taff t o s eek m edical

attention o n y our b ehalf.

Can your child swim? ________________________

7. Y ou a uthorize C amp M acLeod t o u se

any p hotographs t aken o f y our c hild w hile

If yes, at what level? _________________________

participating i n C amp M acLeod p rograms

for f uture p romotional m aterials.

Name and Date of camp ______________________

wishing to attend:

Signature: _ _________________________ D ate:

______________________

_______________

*A separate health form will be provided

that must be completed and signed for

EACH camp attended*

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