Anglican Diocese of Edmonton Mission: To invite and assist campers and staff to grow in Christian discipleship by means of Christian community within an enjoyable camping atmosphere. BASE CAMP BASE CAMP CAMP EXPLORE CAMP EXPLORE *CAMP COME ALIVE *CAMP COME ALIVE (*Now Hastings Lake Bible Camp) (*Now Hastings Lake Bible Camp) (*Now Hastings Lake Bible Camp) SUMMER CAMPS SUMMER CAMPS SUMMER CAMPS 2010 2010 2010 Featuring: Featuring: Featuring: www.edmonton.anglican.org MEDICAL 1 st Emergency Contact Name: Relationship to Camper: Contact Number: 2 nd Emergency Contact Name: Relationship to Camper: Contact Number: Doctor’s Name: Doctor’s Phone Number: Alberta Health Care Number: Other Insurance Information: Does the participant have any ongoing illness? Is the participant currently on or needing any medica- tions? Please list and bring, in the original container with the original label attached, any prescription and non-prescription medications (Tylenol, Tums, Gravol, herbal remedies, etc.) the participant may need, with written instructions for administering the medication. Does the participant have asthma or hay fever? How severe? Has the participant had a life threatening reaction to common allergens? (ex: bees, insects, food, or drugs such as penicillin). Please list. With regards to special needs children, please refer enquiries to the attention of the Camp Director. MEDICAL Cont. Does the participant have a condition that requires a special diet? Are there are any special issues, conditions, behavioral concerns or special instructions in regards to your child we should be aware of? What do you as a parent do to support your child? If there is not enough room on this form, please feel free to attach additional pages. In case of emergency every reasonable effort will be made to contact parents/guardians and then the emer- gency contact person. In the event I cannot be reached: I hereby give permission to the medical person selected by the camp staff to provide proper treatment for my child. I state that all relevant and important information is listed above. Parent/Guardian Signature: Date: I give permission for photographs of the camper and cre- ated materials from the camper to be used in advertising of the Diocese of Edmonton Summer Camps: Yes No Also to be used on the Diocesan Web Site: Yes No Camper’s T-Shirt Size: Please circle (We cannot guarantee availability of sizes, but will do our best!) Youth: Medium Large Adult: Small Medium Large X-Large Camp fees must be paid in full prior to the start of each camp. Please make cheques payable to The Anglican Diocese of Edmonton Summer Camps. Payment options are: Include full payment with registration form. Or Send $25.00 (non-refundable deposit, part of camp fee) with the registration form. 50% of the balance must be received by June 15, 2010. The remaining balance is due 14 days prior to start of Camp. Cancellation: If a camp is cancelled, a full refund will be issued. If a participant withdraws or can- cels their registration, a full refund, minus the $25.00 non-refundable deposit, will be issued. There is no refund one week prior to Base Camp, or Camp Explore. There will be a $20.00 fee charged for all NSF cheques. Camp Directors have the right to withdraw a camper’s application due to camp safety concerns (a full refund will be issued in these cases). The enclosed Registration Form, along with a $25.00 non-refundable deposit, may be mailed to: Anglican Diocese of Edmonton Summer Camps Synod Office 10035 – 103 Street Edmonton, AB T5J 0X5 For more information and/or forms please visit: www.edmonton.anglican.org