Camp Wegesegum

CAMP REGISTRATION FORM 2010

Camp Applied for:		Cabin Mate:
Camper's name:		Age: M/F
Address:		Apt:
City:	Prov: Postal Code:
Home Phone		Tshirt size (adult)	XS
			S
			M
			L
			XL
			XXL
Medicare no:		Expiry:
Family Doctor		Phone:
Has the camper had a tetanus shot in the last 5 years?		Yes: No:
Does the camper require special medical attention or treatment (prior existing condition, allergies, medications, etc.)		Yes: No:
In case of emergency while at camp please contact:
Name:		Phone:
Work #:		Other:
Name of 2nd Contact:
Phone:
email address:

To the Parent or Guardian

I believe my child to be medically fit to undertake all normal
camp activities. I also certify that I will not bring my child to
camp if he/she has symptoms of communicable diseases.
I hereby give permission to the Camp Director or designate to
authorize such medical treatment for my child as deemed
necessary by authorized hospital emergency room personnel or
a licensed practitioner,

If rules are not followed, parents will be notified and the camper
may be asked to leave. While every precaution will be taken to
ensure the good welfare and protection of the applicant camper,
CAMP WEGESEGUM, its DIRECTOR, STAFF, BOARD OF
DIRECTORS, and off-site employees, are hereby released from
any and all liability in the event of any accident or misfortune that
may occur to the applicant camper.

As campers will not bring cell phones to camp, parents can call
the director at (506) 339-6545 if they need to get a message to
their child.