Camp Connections

1. Camper Information

Date of application

First Name *

Surname *

Street Address *

City/Town *

Province/State *

Gender *

Male

Female

Postal Code / ZIP *

Date of Birth (YYYY-MM-DD) *

Age *

Please note that the age range for Junior Camp is 7-11. If you're child will not fall within this bracket by camp and you want them to attend, please contact us before completing the application.

Email Address

Billing Email Address

T-Shirt Size (Please select a size) *

Grade Level (Fall 2017) *

Church Affiliation *

Parent/Guardian Full Name *

Parent/Guardian Home Phone *

Parent/Guardian Cell Phone *

Parent/Guardian E-Mail *

Emergency Contact 1 Full Name *

Emergency Contact 1 Home Phone *

Emergency Contact 1 Cell Phone *

Emergency Contact 1 E-Mail *

Emergency Contact 2 Full Name *

Emergency Contact 2 Home Phone *

Emergency Contact 2 Cell Phone *

Emergency Contact 2 E-Mail *

Dorm Mate or other requests (two names max.)

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Health Cards (OHIP/Medicare) must be dropped off at the registration desk upon arrival at camp. They will be kept on file during camp and returned upon departure *

I acknowledge that my health card will be brought to camp

Provincial Health Insurance Number *

Expiry Date *

Name of Family Physician

Does the applicant have any allergies or food restrictions? (e.g. vegetarian, bee stings, penicillin, plants, etc) *

Yes

No

Since you answered "Yes" above, please list all allergies and/or dietary restrictions (please note, while it is not possible to cater to food preferences, allergies will be respected if we are informed in advance)

Will the applicant be bringing any medication with him/her to Camp? (e.g. Antibiotics, ventilator, ritalin, etc) Please explain: *

Please indicate by checking the boxes if the applicant currently, or within the last three months, has had any of the following:

Please Explain

Does the applicant have any physical, emotional, mental or behavioural concerns or limitations that our staff should be aware of. Please explain:

Does the applicant have a special, identified, learning challenge? *

Yes

No

Since you checked "Yes", please identify any strategies that may help the applicant when faced with a new challenge. Many new activities are introduced in the context of Camp and we attempt to met all needs in this area.

Is there any other health or medical information you feel we should know?

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Includes: food, lodging and Camp shirt. Excludes: transportation to and from Camp

Junior Camp Registration Fee (July 22 - July 26)

Full price registration fee

Will this be your first time at Camp Connections? *

Yes, I'm a first time camper!

No, I'm coming back for more!

Are you taking advantage of the Friends of Camp Connections early registration discounts? *

Yes! I am registering before February 15th ($88.00 early bird discount applies)

Yes! I am registering before March 1st ($53.00 early bird discount applies)

Yes! I am registering before April 1st ($36.00 early bird discount applies)

No. I've missed all the early registration deadlines.

Are you bringing any friends to camp? *

Yes - Please apply the Bring a Friend discount!

No

How many friends?

Please list your friends names:

Are you sending more than one camper from your family? (Please note that the Family Discount applies to the first camper only, not to each sibling) *

Yes - please apply the Family Discount since one of my siblings is also registering for Camp!

No

Total Tuition Payable (Canadian dollars)

DEPOSIT

Please select how you wish to pay today: *

I would like to pay the $50 deposit. I understand I will receive an invoice for the remaining balance.

I would like to pay the full amount

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At Camp Connections, we believe that everyone should have the opportunity to experience camp. That's why we established Friends of Camp Connections (FOCC) - a registered Canadian Charity (BN#859926289RR0001) that raises funds annually to help subsidize the costs of camp. In addition to the discounts listed above, FOCC accepts applications for additional funding assistance from those who feel that the costs of sending someone to camp are beyond their reach. If you wish to complete a Bursary Application for additional financial assistance, please select "Yes, I would like to complete a Bursary Application" below to open the additional fields. The FOCC Board of Directors reviews the applications and awards funding based on individual circumstances.

Please select from the following options: *

Yes, I would like to complete a Bursary Application

No, I do not need to complete a Bursary Applicaiton

Bursary Eligibility: Please read carefully before completing the application below.

Applications for financial assistance will be evaluated based on the following criteria:

Age: Applicants for camp scholarship must be between 7 and 18 years of age.

Financial need: The applicant and the applicant’s sponsor must be unable to afford the full camp fee. Applicants that can show they are willing to work hard to save up or raise funds to cover a portion of the registration fee will be more likely to receive assistance. Personal initiative will be evaluated on a case-by-case basis.

It is important that the sponsor and the applicant attempt to take advantage of the guaranteed subsidies offered by Camp Connections such as the FOCC early registration subsidy or the bring a friend discount. This shows that the applicant is trying their best to afford the opportunity to come to camp.

Personal desire: The applicant should indicate why they would like to attend camp. We will be looking for a desire to be personally affected by camp attendance. While applicants need not be of the same religious background as Camp Connections (i.e. Christian), they must indicate their willingness to participate fully in all camp activities including those of spiritual nature.

Extenuating Circumstances: Another consideration will be whether someone is experiencing some form of life crisis (depression, family problems, etc.) which give extenuating circumstances and which creates a need for camp as an assist toward regaining balance in life.

Please explain how Friends of Camp Connections can assist you or the applicant with tuition fees. (please include a brief explanation of the financial situation)

Please indicate an amount you are able to contribute towards the registration fee to help us ensure we can support as many campers as possible:

Which discounts/incentives are you or the applicant taking advantage of?

None

Early Registration (FOCC Sponsorship)

Bring a Friend Discount

Family Discount

Friends of Camp Connections supports campers in partnership with several organizations. Please indicate any affiliations through which you are hoping to receive funding. Please reference any correspondence you have had with Camp Connections regarding funding:

If you have already spoken to someone regarding additional funding, please let us know who you spoke with:

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Please be informed that many photos are taken during Camp; some of these photos may be used on our webpage, or in Grace Communion International publications. Generally campers are not identified by name. We cannot guarantee a group photo including your applicant will not be used. Camp Connections may use any photos and videos taken that include the applicant at any Camp Connections event in its publications or those of its sponsors, Generations Camp Ministry, Grace Communion International and Friends of Camp Connections.

Parent/Guardian *

I have read and understood the consent and release above and I agree

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6. Parental Consent and Camp Connections Release

I/We recognize the risks of physical and aquatic activities. I am/We are satisfied with the precautions taken for the health and safety of my child at Camp. I/We covenant not to sue and to release, indemnify and save and hold harmless, Grace Communion International, the Camp Connections Camp Planning Team, all their affiliated organizations and boards of trustees or directors, officers, agents and employees, and Camp counselors or helpers, from and against claims or suits brought against the Church or camp based upon or resulting from material, moral or bodily injuries sustained by or arising out of, or in the course of, attendance at Camp.

Parent/Guardian *

I have read and understood the above disclaimers and agree to abide by them

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As a Camper, I will strive towards conduct as defined by Jesus Christ in the two great commandments, “love towards God, and love towards neighbour.” I understand that the expectations at Camp include being respectful and cooperative, reflecting modesty in dress and appearance as appropriate for the activity, abstaining from pairing off, sexual activity, offensive language, possession or use of intoxicants, or illegal drugs. I understand that I am expected to participate fully in all activities, unless exempted by camp administration. I understand that I am to wear appropriate clothing for the activities, as outlined on the camp web-site. I understand that failing to abide by the rules and standards of the Camp can result in my being sent home at the expense of my family.

Applicant (Camper) *

I have read and understood the above declaration and I agree to abide by it

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8. Health Insurance and Liability Waiver

Without exception, all campers must bring their provincial health card (or equivalent if visiting from outside of Canada) to Camp with them. Applicant must be covered by Provincial Health Insurance or equivalent medical insurance. The Camp program requires campers to engage in a wide range of physical activities. Good health and fitness are important. Precautions are taken for the safety and health of campers, but in the event of accident or sickness, Grace Communion International, its staff, and its volunteers are hereby released from any liability.

Parent/Guardian *

I have read and understood that above and I agree

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By law, the administration of medication, including over-the-counter medication (such as Tylenol and Aspirin) to campers or personnel 18 or under MUST be approved by a legal guardian, and administered by the appointed Camp health personnel. In the event that a camper requires medical attention while at Camp, on site first aid personnel will asses the situation and deal with minor injuries, including the administering of over-the-counter medications when deemed appropriate. In the event of a medical emergency, or other health issue deemed to require further medical attention, the situation will be referred to the local hospital or clinic. The parent/guardian will be notified immediately of any serious medical issues including the need for special medication, x-rays, or other serious treatments.

Parent/Guardian *

I hereby agree that over-the-counter medications (such as Tylenol, Aspirin etc) may be administered to this camper by camp appointed health personnel.

Parent/Guardian *

In case of surgical emergency, I hereby give permissions to the attending physician to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child as named above.

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Is there anything else you wish to add that has not been covered elsewhere in this application?

I agree that my typed name below is the electronic equivalent of my written signature and that I agree with all of the statements on this application and acknowledge that I have given the most accurate and current medical information possible. *

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Social Links

Junior Camp Registration

1. Camper Information

2. Camper Health Information

3. Registration Fees

4. Bursary Application

5. Parental Consent and Photo Release

6. Parental Consent and Camp Connections Release

7. Applicant Code of Conduct Declaration

8. Health Insurance and Liability Waiver

9. Medical Issues and Administration of Medication

10. Sign and Submit