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CAMP WONDER

Camp Registration

Thank you for your interest in CAMP WONDER! We are excited to have your child join us this summer. Please complete the form below to register your child(ren) in camp!

Registration cost is $150/week for full days (9am-4pm) or $75/week for half days (9am-12pm or 1-4pm).

Cheques can be made payable to Opal Family Services.

Questions? Please call 506-457-9520

Please complete registration form below

Camper Info

* Indicates required field

Camper's Name *

First

Last

Date of Birth (DD/MM/YYYY) *

Medicare Card Number *

Gender *

Female Male Other

Please select which week(s) you are applying for *

Week 1: July 6 - 12 (ages 6-12) Week 2: July 13 - 17 (ages 5-8) Week 3: July 20 - 24 (ages 13-19) Week 4: July 27 - 31 (ages 6-12) Week 5: Aug 7 - 7 (ages 6-12) Week 6: Aug 10 - 14 (ages 6-12) Week 7: Aug 17- 21 (ages 13-19) Week 8: August 24 - 28 (ages 13-19)

Duration Preference *

Half Day Full Day

Family Info

Parent/Guardian #1 *

First

Last

Relationship to Camper *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number #1 *

Phone Number #2 *

Parent/Guardian #2 *

First

Last

Relationship to Camper *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number #1 *

Phone Number #2 *

With Identification the following People have permission to pick up my camper *

First

Last

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Relationship to my child *

Camper Wellness Info

Please describe the special needs of your child that camp staff should be aware of: *

Current Medical Information *

Type 1 Diabetes Type 2 Diabetes Bleeding/Clotting Cerebral Palsy Heart diseases/Defect Epilepsy None

If you checked box(s) above, please provide more information about your camper below. (Ie. Epilepsy: Specific causes) *

Please list all medications your child is currently taking. Include Name, Condition it treats, dosage, administration time, and any further instructions you feel necessary *

Allergies

Please describe all allergies your child has. Including allergin name, type of reaction, and treatment (epipen/benadryl) *

If Epi-Pen treatment has been indicated above, please ensure that your child brings it with them to camp and that staff are aware of its location. *

Asthma Wheezing with breathing Wheezing with Exercise Wheezing from environmental allergins

If yes to ASTHMA please indicate triggers *

Dietary Info

Does your child have any dietary restrictions? *

Halal Lactose-Intolerant Vegetarian Gluten-Intolerant Celiac None

Other Dietary restrictions not listed above? *

Additional Info

By answering the following questions below, we will be able to determine how we can best support your child so that he/she has a successful experience at camp.

1. Does your child require additional assistance with anything (e.g: hygiene, verbal instructions, tying shoes, physical or emotional needs, etc.) *

2. Does your child use any special equipment and devices? Will your child have these at camp? *

3. How can we help your child if he/she does not seem to understand what we are trying to communicate? *

4. What are your child’s favourite activities? (eg: strengths, abilities, preferences) *

5. Does your child have a support person? Will the support person be accompanying the child to camp? Why or Why not? *

6. Does your child have any difficulty in new situations, noisy or crowded places? Does your child run away or become agitated? What is the best way to manage these situations? *

7. Do you have any more suggestions for how can we help your child succeed at camp? *

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About Camp
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