Bethel Park Youth Camp 2017 Student Registration & Medical Form

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Bethel Park Youth Camp 2017 Student Registration & Medical Form 2210 Warden Avenue Toronto, ON M1T 1V6 416-494-2201 ext. 23 youthcamp@bethelpark.ca www.bpnextgen.

1 Bethel Park Youth Camp 2017 Student Registration & Medical Form 2210 Warden Avenue Toronto, ON M1T 1V ext PLEASE BE ADVISED THAT MUCH OF THIS FORM HAS CHANGED FROM PREVIOUS YEARS. BE SURE TO CAREFULLY READ EVERY SECTION. Please ensure that the application is COMPLETELY filled out before submitting to Bethel Park Next Generation. Failure to do so will result in you receiving an (if you have provided one) informing you that your form was incomplete and that you must print and send a new one. This will delay the registration of your child. If the replacement form is received after the early-bird deadline, you will be expected to pay the standard rate. Please double check all areas to ensure they are filled out including fill in the blanks and signatures required by both parent & student. Student General Information Student First Name: Student Last Name: Student is: M F Date of Birth: Age: Home Church: Day Month Year Street Address: City/Prov.: Student Phone #: Health Card #: Expiry: * If Health Card number & expiry is not provided, an invoice will be sent directly to the parent/guardian for any medical expense incurred by camp staff or volunteers with expectation of reimbursement. Parent/Guardian General Information Mother/Guardian Name: Same Address? Yes No If no, write here: Mother/Guardian Home Phone #: Cell Phone #: Work Phone #: Father/Guardian Name: Same Address? Yes No If no, write here: Father/Guardian Home Phone #: Cell Phone #: Work Phone #: In an event where the parent/guardian cannot be reached in the unlikely event of an emergency, please indicate another emergency contact for your student. This contact must be over the age of 18 and should have a personal relationship to the student and/or guardian (i.e. not a family doctor). Emergency Contact Name: Relationship to Student: Home Phone #: Cell Phone #: 1

2 Medical Release Information Please state, in detail, any medical conditions that we should be made aware of. This should include any illness, disease, condition, recent surgeries/sickness, chronic pain/headaches, asthma, mental health, etc.: Please list any medications that the student may need. This includes pills, puffers, inhalers, epipens, etc. All medications must be in original bottles with clear dosage instructions. Please note that for the safety of all students and staff, any and all medications must be given to the nurse upon camp checkin. Medications will be closely monitored and distributed by only the camp nurse. Of course, exceptions can be made for puffers in the case of extreme asthma or epipens in the case of extreme allergies, so long as these instructions are given below. Does your child have any allergies? Yes No If yes, please indicate here: Are there any behavioural concerns we should be aware of with your child? Yes No If yes, please explain here: 2

3 Camp T-shirt Information All students have the opportunity to pre-order camp shirts with their registration to ensure sizing and availability. Please place a check mark in the box corresponding to the size you would like, note the price of the shirt, and add it to your overall registration cost. How many T-shirts? Choose sizes below: XS S M L XL XXL *Please add $25 per shirt to your registration payment for the t-shirt cost. Failure to do so will result in the student not receiving a t-shirt without warning. Payment & Method There are 2 available options for payment that you can see below. Please indicate which method of payment you will use by checking one of the boxes below. Option 1-- Mail in Cheque Mailing address: 2210 Warden Avenue Toronto, ON M1T 1V6 IMPORTANT NOTE: Cheques MUST be made out to Bethel Park Next Gen Failure to do so will result in you receiving an that you must send a new one; the previous one will be destroyed. This will delay the registration of your child. If the replacement cheque is received after the early-bird deadline, you will be expected to pay the standard rate. Option 2-- Money Transfer Send to: bookkeeper@bethelpark.ca Security Question: What is the camp retreat theme? Answer: reach Note: answer is case-sensitive; use all lowercase letters IMPORTANT NOTE: Any Money Transfers made to any other address will NOT be accepted. We will NOT accept the transfer if you do not use this given security question and answer. If you choose to use another security question and answer, this will delay the registration of your child. Only when the correct security question and answer are used will your money be accepted. If this occurs after the early-bird deadline, you will be expected to pay the standard rate 3

4 Bussing Information Will your child require a ride to camp on the bus? Yes No If yes, indicate which pickup location below. Location 1- Warden Full Gospel Assembly Location: 2210 Warden Ave. Toronto, ON M1T 1V6 Pick-up Time: 1:30pm Sunday August 13 th, 2017 Location 2- Cambridge ONROUTE Gas/Food Station Location: Westbound side of Highway 401 between the exits for Highway 6 & Highway 24 Pick-up Time: 3:00pm Sunday August 13 th, 2017 *Cost for travelling on the bus is $40/person for a return trip to and from Bethel Park Camp. Please include this within your registration payment. Failure to do so will result in your child not being on the bus list. If your child only requires a one-way trip, the cost is still $40/person to reserve their spot. Registration Cost Early-Bird Rate - $290 Only check this if your COMPLETED form and FULL payment will be RECEIVED by camp administration BEFORE June 25 th, 2017 If the COMPLETED form and/or FULL payment are received after this date, you will be contacted and expected to pay an additional amount totalling the standard rate. Standard Rate - $315 Please check this if your COMPLETED form and FULL payment will be RECEIVED by camp administration AFTER June 25 th, 2017 and BEFORE August 7 th, 2017 If the COMPLETED form and/or FULL payment are received after this date, you will be contacted and expected to pay an additional amount totalling the standard rate. Late Rate- $380 Please check this if your COMPLETED form and FULL payment will be RECEIVED by camp administration AFTER August 7 th, 2017 Registration Payment Calculator Registration Cost: T-shirt Cost: Bus Cost: TOTAL COST: Please note: If your costs are miscalculated, your registration is incomplete until all funds are received. This will delay the registration of your child. If the total cost is paid in full after the early-bird deadline, you will be expected to pay the standard rate. 4

5 Accommodations Information Please choose one of the following options: My child will be staying in a private cabin If you checked this option, please be advised that the cabin owner will be contacted to make sure that they are aware. Please provide: Cabin Owner Name: Cabin Owner Phone #: Cabin Address: My child needs accommodations to be arranged by Bethel Park Next Generation If you checked this option, please provide names of one (1) to three (3) other campers that your student would like to be roomed with. We cannot guarantee that these roommate accommodations will be met, but we will make every effort to try. If any of the students named have indicated that they are staying in private cabins, the accommodation cannot be made Please note: The information given in this section of this form is final. Students will NOT, for any reason, be allowed to change their accommodations once they are at camp, whether situated in a private cabin or a provided cabin. Student Code of Conduct 1. Modest clothing must be worn at all times (underwear is not to be seen). 2. Modest bathing attire must be worn during beach/pool excursions, i.e. girls are not to wear bikinis, guys are not to wear speedos or spandex. 3. Campers and parents are expected to abide by the pre-organized accommodation arrangements and cannot expect any changes to be made on registration day or at any point during the camp week. 4. Campers are expected to be on time and participate in all activities and services. Consistent lateness will result in a camper being sent home. Campers are to cooperate with their Camp Counsellors in completing regular check-ins and attendance. This is because we must know where the campers are at all times. 5. Anyone choosing to go home early or anyone who has been sent home early will not receive a full or partial refund. 6. Bethel Park Youth Camp is not responsible for any lost or stolen items. 7. Behaviour deemed unacceptable to the spiritual and moral character of the camp will not be tolerated and may result in camp discipline which may include: assignment of additional chores, calls to parents, camper being sent home, etc. 8. Individuals and/or their parents will be responsible to pay for any damages done to the camp property or individual cabins. Pranks that damage property, hurt another person or their personal property, involve firecrackers, smoke/stink bombs, etc. will not be tolerated and appropriate disciplinary measures will be taken, up to and including being sent home. 9. Campers will be IMMEDIATELY sent home if caught in an accommodation of the opposite sex. 10. By law, the police will be called to handle any campers who possess drugs or alcohol, vandalize, steal, assault, or make a threat of assault to another person. 11. Smoking is not permitted on the campgrounds. 5

6 12. As meals are provided, campers are not to have BBQs, whether they are accommodated in private cabins or camp facilities. Due to safety concerns, the use of propane stoves is strongly discouraged and Bethel Park Youth Camp will not be held responsible for any injuries or damage associated with such use. 12. Campers are not permitted to be out of their cabins after curfew or to have after hour socials or BBQ s. If a camper is found not to comply with the above, appropriate disciplinary measures will be taken. Campers are expected to cooperate with Camp staff during random room checks whether they are accommodated in camp facilities or private cabins. 13. Campers are not to leave the grounds without permission. Campers are expected to park their vehicles for the duration of camp. If a camper fails to comply with this rule then they will be sent home. 14. Fireworks are not permitted on campgrounds. Any camper found with fireworks in their possession will be sent home immediately. 15. Respect and listen to all volunteer leaders because they have given up a week of their life/work to make camp possible for you. By signing below, I indicate that I as a student, have read, understood, and agreed to the above code of conduct. Student Name (Printed): Date: Student Signature: Media Release Agreement I hereby grant the staff of Bethel Park Next Generation permission to take pictures and video of myself/my child for camp promotional purposes only. Parent/Guardian Signature: Date: Student Signature: Date: Parent Waiver/Release Agreement I hereby grant permission for the above named student to attend Bethel Park Youth Camp, and authorize camp staff to care for him/her including any necessary medical treatment. I also release my child to be involved in sports and off site trips to the beach. I release Bethel Park Next Generation and Bethel Park Camp of any liability in the event of an accident or illness. I accept responsibility for any medical expenses that may occur for my child. By signing below, I indicate that the information given in this form is, to my knowledge, accurate, correct, and complete. Any information that is inaccurate or incorrect, resulting in the safety and/or security of my child and other students and staff at Bethel Park Youth Camp, is my responsibility. I also understand that if any part of this form is incomplete and/or the owing cost is not paid in full by the appropriate due date, that it will delay the registration of my child, and that if the replacement form and/or owing balance is received after the early-bird deadline, that I will be expected to pay the standard rate, or may even be unable to register my child if received after the standard rate deadline. By signing below, I also indicate that my child has read, understood, and agreed to the Code of Conduct and all of the rules and agreements specified above and throughout this registration form. Parent/Guardian Signature: Date: 6

YMCA OF GREATER NEW YORK SUMMER CAMP REGISTRATION FORM

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