Trent Summer Sports Camp
Camper Health & Personal Information Form - 2012 Season
This form must be completed each year and send to the Camp office before the start of camp. Fields marked with an asterik (*) are required.

Your specific comments and information will be shared in confidence with camp staff so we may be sensitive to your child's needs and unique characteristics. Please note that this is not a secure site. Theoretically, it may be possible for others to view your information while it is being sent to us.

If you have any questions or problems, please contact the Camp Office at 705-748-1670.

RETURN TO CAMP


Camper's Name
Ontario Health Card No.
If you reside outside of Ontario, please send a copy of your insurance or health coverage to the camp office.
Date of Birth:
Allergies
(food, drugs, environmental)
Medication or treatments
required while at camp

Special Needs, limitations, or other general information to be shared with camp staff:

Swimming It is our practice to test each camper's swimming ability. If you require your son/daughter to wear a lifejacket, please check here:
LIFEJACKET REQUIRED?
(If "YES", we will not test your son/daughter)
Other comments or restrictions about swimming abilities:
Pick Up List Please list individuals who may pick up this camper from camp during the session. Parents and/or guardians are automatically included unless otherwise noted.
Family/Emergency Contact Information
(please feel free to email a note concerning custody arrangements, if applicable)
Parent/Guardian #1
Daytime telephone number for Parent/Guardian #1
Parent/Guardian #2
Daytime telephone number for Parent/Guardian #2
If parents are unavailable,
Emergency contact name:
Emergency contact phone:

Family Physician:

Please read carefully
My electronic signature below confirms permission for my child to fully participate in all activities at the Trent Summer Sports Camp, including those supervised trips and programs not on camp property. Any and all factors which would prevent or limit his/her full participation in all camp activities have been noted, and disclosed to camp staff. In the case of emergency, and I/we are not immediately available for consultation, I hereby give permission to the Physician selected by the Camp Director to hospitalize, secure proper treatment for and to order injections, anaesthesia or surgery for the above-named child. I also authorize my child's family physician or specialist who may be currently treating my child to release any medical information concerning my child's previous or current medical history or condition to the Director of the Camp and/or any Physician selected by them to treat my child pursuant to the authorization given herein. I further agree to the sharing of personal information about my child with the appropriate camp staff and those associated with the operation of the camp, at the discretion of the Director.

By choosing to submit this form electronically, I agree that by entering my name in the space below, I certify the information provided is true and correct, and legally obligate myself to the extent as I would by signing my name on a printed version of this form.

Registration Submitted by: *
(this is your online signature)
E-mail: