Rejoice In The Lord

Please Print this form, fill it out, Mail the registration form with full payment or $25.00 deposit with cheque post dated with remaining balance on or before July 15, 2008 to: Sheila Duncan,1227 Baker Street. Peterborough, Ontario  K9H 7P9 (705) 749-6153
“Please make all cheques payable to “Trent Valley Baptist Camps”

Camp Kara 2008 Registration & Health Information Form

Camp Kara 2008 Registration & Health Information Form

Enclosed: ? Full Fee ($340) ? $25 non-refundable deposit & cheque for balance of fee post-dated July 15th

Cabin Mate Preference(s): –please limit to 3___________________________________________________________________

Allergies (Please Circle):

Specify treatment required:________________________________________

Medications Camper May Be Given If Needed (please circle):

Medications Brought to Camp
Please provide medication name, dosage, frequency and administration instructions.

3.)________________________________________________

All medications must be in original containers and clearly labeled with camper’s name and dosage and administration instructions

I/we have read, declare and agree to the following:

I have legal responsibility for the above-named camper, who is covered by Ontario or equivalent medical insurance.
All of the above information is correct and up-to-date. Any change prior to camp will be reported upon registration.
The camper is in good physical health, and to my knowledge, has not been in contact with any infectious diseases.
Any exposure to infectious diseases within 4 weeks of camp will be immediately reported to the Camp Registrar
The Camp Director must be information immediately of any special medical/behavioral needs and reserves the right to
require parents to provide additional support should the camper’s needs surpass the camp’s capabilities.
The Camp Director has the right to dismiss without refund any camper who is in his/her opinion a hazard to the health or
safety of others or who is rejecting the reasonable discipline of the camp.
Although the camp leaders will provide for the health and safety of the camper, accidents, illness & misadventure may
occur. Camp Kara and paid/volunteer staff are released from all liability.
Permission is given for the camper to participate in off-premises activities (i.e. canoe trips) if applicable.
Pictures may be taken of the camper during normal camp activities and used for promotional purposes.
I authorize the appropriately trained Camp Nurse/First Aid Personnel to provide routine medical assistance.
In the event of an emergency, if unable to contact a parent/guardian, the Camp Director is given permission to act on the
parents’ or guardians’ behalf in signing for special medical care as advised by a Medical Doctor, including medical tests,
treatment, surgery or anesthesia as necessary.
All campers will be inspected for head lice upon registration and will not be permitted to attend camp as
long as any evidence of head lice is present.

Signature of Camper:__________________________________________________