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Camper Registration 2024

How many campers are you registering today?

Parent Guardian First Name

Email

Parent Guardian Last Name

Phone

Street Address

City

Postal / Zip code

Emergency Contact Information

Emergency Contact Name

Family Doctor Name

Emergency Contact Phone

Family Doctor Phone

Camper #1

First Name

Last Name

Health Card Number

Birthdate

Choose your Camp

Week 1 - June 23- June 29 (Ages 7-11)

Week 2 - June 30 - July 6 (Ages 7-14)

Week 3 - July 7 - July 13 (Ages 7-14)

Week 4 - July 14 - 20 (Ages 7-14)

Week 5 - July 21-July 27 (Ages 11-14)

Gender

Male

Female

Arrival at camp:

Bus

Drop Off (10:30am)

Does the Camper have any allergies, chronic illness, or medical conditions?

Does the Camper require any prescription medication?

Are there any other issues or considerations that we should be aware of and/or accomodate for?

Camper #2

Camper First Name

Health Card Number

Birthdate

Gender

Female

Male

Camper Last Name

Choose your Camp

Week 1 - June 23- June 29 (Ages 7-11)

Week 2 - June 30 - July 6 (Ages 7-14)

Week 3 - July 7-13 (Ages 7-14)

Week 4 - July 14 - 20 (Ages 7-14)

Week 5 - July 21 - 27 (Ages 11-14)

Arrival at camp:

Bus

Drop Off (10:30am)

Does the Camper have any allergies, chronic illness, or medical conditions? If yes, please describe.

Does the Camper require any prescription medication? If yes, please explain any instructions.

Are there any other issues or considerations that we should be aware of and/or accomodate for?

Camper #3

Camper First Name

Health Card Number

Birthdate

Gender

Female

Male

Camper Last Name

Choose your Camp Week

June 23- June 29 (Ages 7-11)

June 30 - July 6 (Ages 7-14)

July 7-13 (Ages 7-14)

July 14 - 20 (Ages 7-14)

July 21 - 27 (Ages 11-14)

Arrival at camp:

Bus

Drop Off (10:30am)

Does the Camper have any allergies, chronic illness, or medical conditions?

Does the Camper require any prescription medications?

Are there any other issues or considerations that we should be aware of and/or accomodate for?

Consent

I hereby give permission to the qualified practitioner appointed by Camp Bickell to provide medical treatment within their scope of practice. I also allow my child to be transported to a local hospital in a medical emergency .

Yes

No

Do you allow the use of your child's image in Camp Bickell promotional material, website and other advertising?

Yes

No

Payment

Click below to select total number of camper weeks to be booked.

For example; Camper #1 is staying two weeks, Camper #2 is staying one week = 2 weeks +1 week = 3 total weeks.

RATE: $500 for the first week, $450 for additional weeks. Select the total number of weeks you are attempting to book.

You will be redirected to our payment provider to complete payment.

Total Number of Camper Weeks?

One Week - C$500

Two Weeks - C$950

Three Weeks - C$1400

Four Weeks - C$1850

Five Weeks - C$2300

Six Weeks - C$2750

Seven Weeks - C$3200

Eight Weeks - C$3650

Thanks for submitting!

© 2024 Stephen Roy Weir

Peasy Consulting
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