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for Important Information on drop off, pick up, camp rules and what to bring.

BONNYVILLE BAPTIST

CAMP SHEKINAH - REGISTRATION

Please (print and) return this form to:Camp Shekinah Registrar, Bonnyville Baptist Church, 4111 - 43 Avenue, Bonnyville, AB   T9N 1S7or Fax: 780-826-1886 (if faxing use black pen).

Applying for: __ Junior Camp or __ Teen Camp                    Age as of camp date:___  

Name: _____________________________________      Birthdate:____________________ Gender: M ___ F ___                                                                                                              (MM/DD/YY)                                                                                                    Address: ________________________________________________________       Postal Code: ______________

Phone: (      ) ____ - ________  E-mail: ____________________________    Church Affiliation: ________________                                                                        

 Alberta Health Care #:___________________________      Alberta Blue Cross #: ___________________________                                                                                                                                            Special Health (include any allergies and emergency medications) and/or Learning Needs: ____________________________________________________________________________________________       Birth marks, scars, bruises or other injuries or rashes (indicate size and location): ____________________________________________________________________________________________                                                                                            

Custodial Parent(s)/Legal Guardian: Mother:___________________________Father:_____ __________________________________                                                           

Non-Custodial Parent, if applicable:________________________Relationship to Child:  ______________________              Address:__________________________________________________________Authorized designate other than custodial parent(s) who may pick up child and serve as contact in your absence: Name and Phone #_____________________________________________________________________________ 

Privacy Matters: May we include your child in any photos taken at camp? ___Yes___No. If you do not want your child included in any pictures for promotional purposes please check here [     ].  

We would like you to feel more comfortable at camp, so if you wish, who would you like to bunk with at Camp Shekinah? _______________________________  (we will try to put you with one of your requests.) 

Are you also going to the MOOSE LAKE (MALLAIG) BAPTIST BIBLE CAMP? ____ Yes ____ No  

INCLUSIVE CONSENT, WAIVER AND MEDICAL RELEASE FORM

(This must be read and signed by custodial parent/guardian and by the child/youth if age 14 yrs. or older) 

I/we give permission for my child/youth as named above to attend junior/teen camp.   I/we understand that precautions are taken for the safety of my child/youth, and I hereby release Bonnyville Baptist Church, its staff, and its volunteers from any liability pertaining to any and all risks associated with attending camp, including travel. 

In the case of emergency, I/we give permission to the leaders of the camp to secure proper treatment for my child/youth named on this form with the assurance that I/we will be notified as soon as possible.  In the case of surgical emergency, I/we hereby give permission to the physician selected by Bonnyville Baptist Church to hospitalize, secure proper treatment for, and to order injection, anaethesia or surgery for my child/youth as named above.    

My child/youth agrees to abide by the "camp rules" and I/we will take responsibility should there be any disciplinary problems with my child/youth.                                                                                                 

 Parent/Guardian Signature:_________________________________     Date:________________________                                                                                                                                   

Camper’s Signature (if over 14yrs) ___________________________       Date:  ________________________