Teen Retreat Girls - Individual Registration

Please enter information in the form below to register for Teen Retreat Girls.

Once payment has been made, camp registration is final and no refunds will be given. Please take note of this.

First Name *

Last Name *

Email *

What age is the camper? *

Date Of Birth *

Sex *

Female

Address *

Address 2

City *

Postal Code *

Country *

Province

Phone

Secondary Phone

Camper Lives With *

Father

Mother

Both

Other

If Other *

Fathers Full Name

Mothers Full Name

Guardians Full Name

Camper Experience

Have you been a camper at Blomidon before? *

Yes

Cabin Mate Requested

Describe the campers ability to swim? *

Afraid of Water

Weak Swimmer

Average Swimmer

Strong Swimmer

T-Shirt Size *

Medical History

Does your camper have any known allergies? *

Yes

Please list known allergies

Does the camper take any daily medications? *

Yes

Please list medications, what they are for, and when they are to be taken.

Does your camper

Sleep Walk

Wet The Bed

Date of last tetanus shot *

Emergency Contact 1 Full Name *

Emergency Contact 1 Phone Number *

Emergency Contact 2 Full Name

Emergency Contact 2 Phone Number

Medicare and Medical Insurance

Health Card Number *

Expiration Date *

Insurance Company

Subscribers Name

Policy Number

ID Number

Is this a registration for a camper with a church sponsorship? *

PARENT/GUARDIAN PERMISSION FORM – PLEASE READ PRIOR TO REGISTERING

1. *

In case of emergency, I understand every effort will be made to contact me. In the event that I cannot be reached in an emergency situation, I hereby give permission to licensed emergency and health care personnel to provide treatment, services and transport necessary to maintain the health of my child. In the event medication, medical advice, treatment and/or equipment are required, I agree to accept financial responsibility for fees in excess of provincial and or private medical insurance. I agree that the information on this form may be disclosed to such emergency and health care personnel. In the event of illness, accident, emergency, or any other circumstance requiring medical treatment, such treatment may be procured for the participant without legal or financial obligation to Blomidon Bible Camp and One Hope Canada. All known health issues of my child have been stated to the camp. I will notify the camp if my child is exposed to any infectious diseases prior to arriving at camp.

2. *

I agree to allow photographs or video of camp activities, which may include my child, to be used in any and all camp promotional material including the sharing of photographs and videos with ministry partners of One Hope Canada.

3. *

have read and understood the terms of this agreement and BY ALLOWING MY CHILD(REN) to participate in the camp, I am voluntarily agreeing to abide to these terms. I confirm that the participant [my child] is physically and mentally able to participate in all activities of the camp, unless specifically indicated otherwise in writing.

4. *

Blomidon Bible Camp reserves the right to request any participant to withdraw from their camp if the participant is not acting in an appropriate and responsible manner.

5. *

We count it a privilege that you are sending your son or daughter to spend the week with us at camp this summer. During a week of camp, we look forward to many great friendships being formed! We have an amazing summer missionary team, and they love to stay connected with their campers throughout the year to hear how they are doing and answer any questions they may have about the topics discussed during chapel session and cabin devotionals. As part of our child and youth protection policy (www.insafehands.ca) we are committed to honouring you as a parent/guardian and to asking your permission before any contact occurs between campers and our missionaries (Faith Spark app, Facebook, Twitter, phone calls, etc.). Our missionaries would be honoured to be able to continue to stay involved in your child or youth’s life after camp. Please initial to indicate whether or not you give permission to our missionaries to stay in contact with your son or daughter. If you wish to discuss this further, please contact the camp director by phone or email (please see camp website for contact information). If you wish to withdraw your permission, please contact the camp office immediately to notify the camp director.

6. *

I agree that once payment has been made, camp registration is final and no refunds will be given.

Payment Information

Optional: At Blomidon Bible Camp, we are committed to offering camp at the lowest cost we can while still covering the basic costs to run the actual camp to allow the most kids from the most families to benefit from camp. There are other costs to camp besides just food and utilities, such as property improvements, and we love to be able to give the people who serve at camp some monetary reward for their service. We also have a fund to be able to help those families who cannot afford camp. If you are able and interested, simply indicate how much you'd like to donate to each fund and that will be added to your total. If you'd like to become a monthly donor for the camp rather than a one-time gift, please click here

Property Fund

Staff Fund

Sponsorship

Amount

Payment Method

e-transfer

Please note that we have split up registration by gender this year. Please make sure you are signing up your child for the correct "Boys" or "Girls" camp.

Registration

Camper Experience

Medical History

Medicare and Medical Insurance

PARENT/GUARDIAN PERMISSION FORM – PLEASE READ PRIOR TO REGISTERING

Payment Information