CAMPER REGISTRATION 2023

Camper Registration Form

Camper Registration Form 2023

Please include all information for Camp Mansfield staff to register your camper(s) accurately. If there is any additional information of a sensitive nature, please feel free to send an email marked 'confidential' to our Camp Manager at campinfo@mansfieldoutdoorcentre.ca.

PLEASE NOTE: You must have already registered through the online website before completing this form.

Parent/Guardian Information

Primary Contact Name(Required)

First Last

Primary Contact Phone(Required)

Primary Contact Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact Name(Required)

Must be different than Primary Contact name. Emergency contact must be above the age of 16, and is authorized to be contacted regarding your camper in the event you cannot be reached.

First Last

Emergency Contact Phone(Required)

Are there any court orders or custody restrictions which would prevent us from communicating with either parent/guardian? If yes, we will contact you with additional information.(Required)

Yes

Please indicate if there is anyone who is NOT allowed to pick up your camper(s).

Online Order Number(Required)

Please indicate the order number you received from your email confirmation. Please check your junk folder if you did not receive this email.

Camper Information

How many campers are you registering?(Required)

Camper #1 Name(Required)

First Last

Camper #1 Date of Birth(Required)

Month

Day

Year

Camper #1 Age(Required)

Gender of Camper #1(Required)

My camper:(Required)

Requires a lifejacket to swim which I will be providing

Can swim with the use of a floatation device (not a life jacket) which I will be providing (PuddleJumper, arm floaties etc)

Does not require a lifejacket to swim

Does your camper have any dietary restrictions?(Required)

Yes

Please list all dietary restrictions for Camper #1.(Required)

Does your camper have any life threatening or non-life threatening illnesses/conditions/allergies?(Required)

Yes

Description of medical condition/allergy (please include ALL relevant information i.e. symptoms, emergency procedures and medication location).(Required)

Will your camper be bringing medication to camp (including puffers, EpiPens, allergy medication etc)?(Required)

Yes

Name of Medication(Required)

Expiration Date(Required)

MM slash DD slash YYYY

My camper:(Required)

Can take own medication when needed

Requires assistance when needed

Directions for Dosage/Storage (i.e. time of day, frequency, method of administration, does it need to be refrigerated):(Required)

Are there any potential reactions to medication/missed medication?(Required)

Consent(Required)

By Signing this Medication Form I give my permission to Camp Mansfield Staff to handle and deliver the aforementioned medication during his/her/their time at camp and release Camp Mansfield from any claims whatsoever that may arise from the handling and delivering of the aforementioned medication by Camp Mansfield Staff. I also understand that it is my responsibility to pick up and drop off the aforementioned medication at the specific program site each day. With the exception of an EpiPen, I understand that Camp Mansfield cannot physically administer or force medication onto a participant.

Camper #1 T-Shirt Size (Not applicable to PD Day Camps)

Extra Small

Small

Medium

Large

Extra Large

Dates and types of camp for Camper #1(Required)

Please indicate the dates of the weeks and the type of camp (Day, Overnight, LIT) you have already registered this camper for.

Camper #2

Camper #2 Name(Required)

First Last

Camper #2 Date of Birth(Required)

Month

Day

Year

Camper #2 Age(Required)

Gender of Camper #2(Required)

My camper:(Required)

Requires a lifejacket to swim which I will be providing

Can swim with the use of a floatation device (not a life jacket) which I will be providing (PuddleJumper, arm floaties etc)

Does not require a lifejacket to swim

Does your camper have any dietary restrictions?(Required)

Yes

Please list all dietary restrictions for Camper #2.(Required)

Does your camper have any life threatening or non-life threatening illnesses/conditions/allergies?(Required)

Yes

Description of medical condition/allergy (please include ALL relevant information i.e. symptoms, emergency procedures and medication location).(Required)

Will your camper be bringing medication to camp (including puffers, EpiPens, allergy medication etc)?(Required)

Yes

Name of Medication(Required)

Expiration Date(Required)

MM slash DD slash YYYY

My camper:(Required)

Can take own medication when needed

Requires assistance when needed

Directions for Dosage/Storage (i.e. time of day, frequency, method of administration, does it need to be refrigerated):(Required)

Are there any potential reactions to medication/missed medication?(Required)

Consent(Required)

Camper #2 T-Shirt Size(Required)

Extra Small

Small

Medium

Large

Extra Large

Dates and types of camp for Camper #2(Required)

Please indicate the dates of the weeks and the type of camp (Day, Overnight, LIT) you have already registered this camper for.

Camper #3

Camper #3 Name(Required)

First Last

Camper #3 Date of Birth(Required)

Month

Day

Year

Camper #3 Age(Required)

Gender of Camper #3(Required)

My camper:(Required)

Requires a lifejacket to swim which I will be providing

Can swim with the use of a floatation device (not a life jacket) which I will be providing (PuddleJumper, arm floaties etc)

Does not require a lifejacket to swim

Does your camper have any dietary restrictions?(Required)

Yes

Please list all dietary restrictions for Camper #3.(Required)

Does your camper have any life threatening or non-life threatening illnesses/conditions/allergies?(Required)

Yes

Description of medical condition/allergy (please include ALL relevant information i.e. symptoms, emergency procedures and medication location).(Required)

Hidden

Description of medical condition/allergy (please include ALL relevant information i.e. symptoms, emergency procedures and medication location)(Required)

Will your camper be bringing medication to camp (including puffers, EpiPens, allergy medication etc)?(Required)

Yes

Name of Medication(Required)

Expiration Date(Required)

MM slash DD slash YYYY

My camper:(Required)

Can take own medication when needed

Requires assistance when needed

Directions for Dosage/Storage (i.e. time of day, frequency, method of administration, does it need to be refrigerated):(Required)

Are there any potential reactions to medication/missed medication?(Required)

Consent(Required)

Camper #3 T-Shirt Size(Required)

Extra Small

Small

Medium

Large

Extra Large

Dates and types of camp for Camper #3(Required)

Please indicate the dates of the weeks and the type of camp (Day, Overnight, LIT) you have already registered this camper for.

Camper #4

Camper #4 Name(Required)

First Last

Camper #4 Date of Birth(Required)

Month

Day

Year

Camper #4 Age(Required)

Gender of Camper #4(Required)

My camper:(Required)

Requires a lifejacket to swim which I will be providing

Can swim with the use of a floatation device (not a life jacket) which I will be providing (PuddleJumper, arm floaties etc)

Does not require a lifejacket to swim

Does your camper have any dietary restrictions?(Required)

Yes

Please list all dietary restrictions for Camper #4.(Required)

Does your camper have any life threatening or non-life threatening illnesses/conditions/allergies?(Required)

Yes

Does your camper have any life threatening or non-life threatening illnesses/conditions?(Required)

Will your camper be bringing medication to camp (including puffers, EpiPens, allergy medication etc)?(Required)

Yes

Name of Medication(Required)

Expiration Date(Required)

MM slash DD slash YYYY

My camper:(Required)

Can take own medication when needed

Requires assistance when needed

Directions for Dosage/Storage (i.e. time of day, frequency, method of administration, does it need to be refrigerated):(Required)

Are there any potential reactions to medication/missed medication?(Required)

Consent(Required)

Camper #4 T-Shirt Size(Required)

Extra Small

Small

Medium

Large

Extra Large

Dates and types of camp for Camper #4(Required)

Please indicate the dates of the weeks and the type of camp (Day, Overnight, LIT) you have already registered this camper for.

Names of authorized adults for end of day pickup:

Notes for the Office:

Code of Conduct & Consent

Hidden

Medical(Required)

I understand that if my camper(s) have any life threatening or non-life threatening illnesses or allergies, Camp Mansfield staff will be sending me additional paperwork to complete.

Safety(Required)

The safety of each individual in the program is of the most importance to Camp Mansfield. Each registrant must recognize a personal responsibility to learn and follow at all times the safety and other rules established by Camp Mansfield staff. I hereby agree that any behaviour of the registrant that places him/her/their self or others at risk may result in the registrant's immediate dismissal. I hereby acknowledge and agree that no refund will be granted for dismissal or removal of the registrant. To ensure the safety and wellbeing of all individuals participating in the program, Camp Mansfield reserves the right to alter the program at any time without notice or compensation to the registrant.

Waiver(Required)

I agree to sign a Mansfield Outdoor Centre waiver for my camper(s) prior to the camp start date.

Camper Registration Form

Camper Registration Form 2023

Please include all information for Camp Mansfield staff to register your camper(s) accurately. If there is any additional information of a sensitive nature, please feel free to send an email marked ‘confidential’ to our Camp Manager at campinfo@mansfieldoutdoorcentre.ca.

PLEASE NOTE: You must have already registered through the online website before completing this form.

Parent/Guardian Information

Primary Contact Name(Required)

First Last

Primary Contact Phone(Required)

Primary Contact Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact Name(Required)

Must be different than Primary Contact name. Emergency contact must be above the age of 16, and is authorized to be contacted regarding your camper in the event you cannot be reached.

First Last

Emergency Contact Phone(Required)

Are there any court orders or custody restrictions which would prevent us from communicating with either parent/guardian? If yes, we will contact you with additional information.(Required)

Yes

Please indicate if there is anyone who is NOT allowed to pick up your camper(s).

Online Order Number(Required)

Please indicate the order number you received from your email confirmation. Please check your junk folder if you did not receive this email.

Camper Information

How many campers are you registering?(Required)

Camper #1 Name(Required)

First Last

Camper #1 Date of Birth(Required)

Month

Day

Year

Camper #1 Age(Required)

Gender of Camper #1(Required)

My camper:(Required)

Requires a lifejacket to swim which I will be providing

Can swim with the use of a floatation device (not a life jacket) which I will be providing (PuddleJumper, arm floaties etc)

Does not require a lifejacket to swim

Does your camper have any dietary restrictions?(Required)

Yes

Please list all dietary restrictions for Camper #1.(Required)

Does your camper have any life threatening or non-life threatening illnesses/conditions/allergies?(Required)

Yes

Description of medical condition/allergy (please include ALL relevant information i.e. symptoms, emergency procedures and medication location).(Required)

Will your camper be bringing medication to camp (including puffers, EpiPens, allergy medication etc)?(Required)

Yes

Name of Medication(Required)

Expiration Date(Required)

MM slash DD slash YYYY

My camper:(Required)

Can take own medication when needed

Requires assistance when needed

Directions for Dosage/Storage (i.e. time of day, frequency, method of administration, does it need to be refrigerated):(Required)

Are there any potential reactions to medication/missed medication?(Required)

Consent(Required)

Camper #1 T-Shirt Size (Not applicable to PD Day Camps)

Extra Small

Small

Medium

Large

Extra Large

Dates and types of camp for Camper #1(Required)

Please indicate the dates of the weeks and the type of camp (Day, Overnight, LIT) you have already registered this camper for.

Camper #2

Camper #2 Name(Required)

First Last

Camper #2 Date of Birth(Required)

Month

Day

Year

Camper #2 Age(Required)

Gender of Camper #2(Required)

My camper:(Required)

Requires a lifejacket to swim which I will be providing

Can swim with the use of a floatation device (not a life jacket) which I will be providing (PuddleJumper, arm floaties etc)

Does not require a lifejacket to swim

Does your camper have any dietary restrictions?(Required)

Yes

Please list all dietary restrictions for Camper #2.(Required)

Does your camper have any life threatening or non-life threatening illnesses/conditions/allergies?(Required)

Yes

Description of medical condition/allergy (please include ALL relevant information i.e. symptoms, emergency procedures and medication location).(Required)

Will your camper be bringing medication to camp (including puffers, EpiPens, allergy medication etc)?(Required)

Yes

Name of Medication(Required)

Expiration Date(Required)

MM slash DD slash YYYY

My camper:(Required)

Can take own medication when needed

Requires assistance when needed

Directions for Dosage/Storage (i.e. time of day, frequency, method of administration, does it need to be refrigerated):(Required)

Are there any potential reactions to medication/missed medication?(Required)

Consent(Required)

Camper #2 T-Shirt Size(Required)

Extra Small

Small

Medium

Large

Extra Large

Dates and types of camp for Camper #2(Required)

Please indicate the dates of the weeks and the type of camp (Day, Overnight, LIT) you have already registered this camper for.

Camper #3

Camper #3 Name(Required)

First Last

Camper #3 Date of Birth(Required)

Month

Day

Year

Camper #3 Age(Required)

Gender of Camper #3(Required)

My camper:(Required)

Requires a lifejacket to swim which I will be providing

Can swim with the use of a floatation device (not a life jacket) which I will be providing (PuddleJumper, arm floaties etc)

Does not require a lifejacket to swim

Does your camper have any dietary restrictions?(Required)

Yes

Please list all dietary restrictions for Camper #3.(Required)

Does your camper have any life threatening or non-life threatening illnesses/conditions/allergies?(Required)

Yes

Description of medical condition/allergy (please include ALL relevant information i.e. symptoms, emergency procedures and medication location).(Required)

Hidden

Description of medical condition/allergy (please include ALL relevant information i.e. symptoms, emergency procedures and medication location)(Required)

Will your camper be bringing medication to camp (including puffers, EpiPens, allergy medication etc)?(Required)

Yes

Name of Medication(Required)

Expiration Date(Required)

MM slash DD slash YYYY

My camper:(Required)

Can take own medication when needed

Requires assistance when needed

Directions for Dosage/Storage (i.e. time of day, frequency, method of administration, does it need to be refrigerated):(Required)

Are there any potential reactions to medication/missed medication?(Required)

Consent(Required)

Camper #3 T-Shirt Size(Required)

Extra Small

Small

Medium

Large

Extra Large

Dates and types of camp for Camper #3(Required)

Please indicate the dates of the weeks and the type of camp (Day, Overnight, LIT) you have already registered this camper for.

Camper #4

Camper #4 Name(Required)

First Last

Camper #4 Date of Birth(Required)

Month

Day

Year

Camper #4 Age(Required)

Gender of Camper #4(Required)

My camper:(Required)

Requires a lifejacket to swim which I will be providing

Can swim with the use of a floatation device (not a life jacket) which I will be providing (PuddleJumper, arm floaties etc)

Does not require a lifejacket to swim

Does your camper have any dietary restrictions?(Required)

Yes

Please list all dietary restrictions for Camper #4.(Required)

Does your camper have any life threatening or non-life threatening illnesses/conditions/allergies?(Required)

Yes

Does your camper have any life threatening or non-life threatening illnesses/conditions?(Required)

Will your camper be bringing medication to camp (including puffers, EpiPens, allergy medication etc)?(Required)

Yes

Name of Medication(Required)

Expiration Date(Required)

MM slash DD slash YYYY

My camper:(Required)

Can take own medication when needed

Requires assistance when needed

Directions for Dosage/Storage (i.e. time of day, frequency, method of administration, does it need to be refrigerated):(Required)

Are there any potential reactions to medication/missed medication?(Required)

Consent(Required)

Camper #4 T-Shirt Size(Required)

Extra Small

Small

Medium

Large

Extra Large

Dates and types of camp for Camper #4(Required)

Please indicate the dates of the weeks and the type of camp (Day, Overnight, LIT) you have already registered this camper for.

Names of authorized adults for end of day pickup:

Notes for the Office:

Code of Conduct & Consent

Hidden

Medical(Required)

I understand that if my camper(s) have any life threatening or non-life threatening illnesses or allergies, Camp Mansfield staff will be sending me additional paperwork to complete.

Safety(Required)

The safety of each individual in the program is of the most importance to Camp Mansfield. Each registrant must recognize a personal responsibility to learn and follow at all times the safety and other rules established by Camp Mansfield staff. I hereby agree that any behaviour of the registrant that places him/her/their self or others at risk may result in the registrant’s immediate dismissal. I hereby acknowledge and agree that no refund will be granted for dismissal or removal of the registrant. To ensure the safety and wellbeing of all individuals participating in the program, Camp Mansfield reserves the right to alter the program at any time without notice or compensation to the registrant.

Waiver(Required)

I agree to sign a Mansfield Outdoor Centre waiver for my camper(s) prior to the camp start date.