Camp Abegweit Registration Form

If you prefer, you can fill out the form, print it and send it to the address below. Clicking the SUBMIT button below will send the form directly to the Camp Abegweit Registrar.  

Camp Abegweit Registrar
c/o Michele Wilson
PO Box 384
Kensington, PEI
C0B 1M0
Telephone: 902-836-4656
E-mail: michele.wilson@pei.sympatico.ca
  

PLEASE NOTE: All Fields prefixed with an* are mandatory and must be filled in . Filling in all fields will save time for the registrar. Should information be omitted by you, the registar will have to contact you further, thus slowing the application process. Thank-You!

PLEASE NOTE: Do NOT use '(apostrophes) ANYWHERE on this page. Should you use them, the submission will not work and you will get an error. Thanks

Camper Information

  
*Camper First Name
*Camper Last Name
*Camper Address
*Grade Entering (In Sept)
*Camper City / Town
*Gender
Camper Province
*Home Church
*Camper Postal Code
Cabin Share Choice ****see note
Camper Telephone
Camp Week
Camper Cell Number
Swimming Ability
*Date of Birth
T-Shirt Size
       
**** If you and a friend would like to be in the same cabin, indicate the name of your friend(ONE CHOICE ONLY) and YOUR name must also apprear on your friends application for this selection to be considered valid.
Parent / Guardian Information

*Primary Contact Name Father/Guardian Name
*Contact Address Father/Guardian Work #
*Contact City / Town Father/Guardian Cell #
*Contact Province Mother/Guardian Name
*Contact Postal Code Mother/Guardian Work #
*Contact Home Phone Mother/Guardian Cell #
Contact Cell Phone

Receipt Required for Child Care Expenses?
Contact Email Address    
I give permission for my child to travel to/from Camp With the following person(s):
Is there a joint custody arrangement or other custodial information the we should aware of:

 
 
General Health History (please check all present and past ailments )
*Health Card #
*Family Doctor
*Emergency Contact Name
*Emergency Contact Phone
My child is able to participate in active programs without limitations.
Lilitation Descriptions
Appendicitis Measles Bronchitis Convulsions Concussions
Heart Disease Chicken Pox Fainting Toothaches ADHD/ADD
Mumps Bedwetting Skin Rash Sleep Walking Menstrual Problems
Kidney Disease Diabetes Cramps Ear Infections    
Hernia Headaches Asthma Hayfever    
Others(Please List)
Last Tetanus Shot Date    
Has your child been homesick when away from home overnight?  
Allergies (Please List)  
 Food
Sting
Drug
Other
Does your child have anaphylactic reactions?
If you responded to YES above, what to?:
If an allergic response occurs while at camp, please indicate in details what the staff's response should be:
If your son/daughter requires additional support while attending school, he/she may also require additional support while at camp in order to have a successful camping experience. The camp director would be pleased to meet with you prior to the beginning of camp so that adequate preparation can be made for your child. Please describe any extra support which you feel that your child will need while at camp in the box below
Will your child be required to take any medication while at camp?  
If your child is required to take medication while at camp, it is to be given to the Camp First-Aid Coordinator upon arrival at the camp. A nurse is on call for each camp; however, all medication will be administered by the camp's First Aid Coordinator. All medication is kept in a locked cabinet and will be administered according to the parent/guardian's instructions as indicated below.
Name of Medication(1)
Dosage
Instructions for Administration
   
Name of Medication(2)
Dosage
Instructions for Administration
   
Name of Medication(3)
Dosage
Instructions for Administration
   
   
Parental/Guardian Consent:
Experience has shown that in conjunction with camp week activities there are times when illness or accident may occur and immediate surgical or medical attention is necessary. I hereby indicate my permission for the official in charge or his/her deputy to make necessary arrangements for qualified surgical or medical attention for my child/ward in the event of an emergency without necessity of my prior approval. I understand that I will be notified by the quickest means possible if this authority is exercised.
I, the undersigned, after having read, understood and completed the above hereby give my permission for my child/ward to attend and participate in all camp week activities.
*Date *Do you give your consent ?  
 

Medical Consent:
It is my responsibility as a parent to provide the camp director with all pertinent information and to update this information, if necessary, when my child registers on opening day of his/her camp.

*Date *Do you give your consent?  

 
Photo Release :
Camp Abegweit promotes its programs through the use of printed material and the camp痴 web-site. To do this it is necessary to have photographs of campers participating in various activities or samples of writing or crafts. Please advise us if you are willing to have your child痴/ward痴 photograph, voice, writing or craft used for the promotion of Camp Abegweit. The names of campers will not be used. I give my permission for my child痴 photograph, writing or art work to be used for purposes related only to the project described above.
*Date *Do you give your consent?  
       
PayPal Service
For your convenience we now accept payments via paypal. The following screen will give you instructions. Will you be using this service?.
*Please let the registrar know for her records that you will be using this service by selecting YES or NO  

PLEASE NOTE: REGISTRATION WILL NOT BE CONFIRMED UNTIL PAYMENT HAS BEEN RECEIVED. FEES ARE NON-REFUNDABLE EXCEPT FOR MEDICAL OR PASSIONATE REASONS.