Application — FISHER BAY BIBLE CAMP

Please fill out our application for your camper!

Name

First Name

Last Name

Gender

Street/Box

Town

Province

Phone

Age

Birthday

YYYY

Parent/Guardian

Same Cabin As

One name only

Camp to Attend

9 Digit Medical #

6 digit Medical #

Are there any medical issues we should know about?

Allergies

Asthma

Bed Wetting

Epilepsy

Diabetes

Sleep Walking

Other

If any of the above items are checked, please explain

Do we have your permission to authorize medical treatment by a doctor?

Emergency Contact Person

First and Last name required

Emergency Contact Home Phone/Work Phone

I have read the waiver and terms of enrollment on the brochure and am in agreement

Yes

1. The parent/guardian certifies that the camper applicant is normal in condition and habits and is amenable to necessary discipline. The camp director reserves the right to dismiss a camper who in his/her opinion is a hazard to the safety and rights of others, or who appears to have rejected the reason- able controls of the camp.

2. The parents/guardians submitting this application are those having legal custody of the child. Conditions of custody, if applicable, will be fully communicated in writing to the camp, including a photocopy of the section of any court order referring to visitation rights.

3. While all reasonable precautions are taken for the safety and good health of our campers, Fisher Bay Bible Camp, its Directors, and staff members are hereby released from any and all liability in the event of an illness, accident or misfor- tune that may occur to the applicant camper. Each camper must be covered by Provincial Health or equivalent medical insurance. 4. The signature of the parent/guardian on this application shall give the camp director the right to arrange for any special services or other requirements necessary for the best interest of the camper and shall give the camp director or nurse the authority to approve and obtain medical attention necessary for the camper's welfare and good health including injection, anesthesia, surgery, and ambulance. Insuch situations the camp will attempt to notify the parents/guardians as soon as possible. The parents/guardians are responsible for any additional expense that may result from such services!

5. The undersigned releases permission to the camp to use pictures and video of his/her child for camp publications, website and public relations purposes only. The camp will not release any media of campers to the public