2019 Mishewah Youth Camps Registration
Scamps & Champs, Junior & Senior Teen Camps
12
1
2
  • Please Note: At registration a photo will be taken of each camper for our files.

  • CAMPER INFORMATION

  • / /
  • - -
  • N/A if None
  • PARENT/GUARDIAN INFORMATION

  • To be used for invoicing and any neccessary communication regarding camper.
  • - -
  • - -
  • - -
  • EMERGENCY CONTACT INFORMATION

  • - -
  • - -
  • You may request only two campers of similar age, with mutual consent. We try to accommodate reasonable requests, but are unable to make any guarantees.
  • Head Checks

    Consultants from Lice Squad will perform head checks on Scamps & Champs and Jr. Teen campers upon arrival. If lice are found there are two options. 1) The camper will forfeit the week of camp or 2) Lice Services will do the treatment at a cost of $75 + HST per hour. Normally, one hour will treat the camper, sometimes two hours are necessary. Please indicate that you have read this and understand that it is your responsibility to check your camper at home prior to camp. Refunds are not given for a camper who arrives at camp and returns home for treatment. Please be diligent and check at home. Please indicate that you have read this and understand that it is your responsibility to check your camper at home prior to camp.
  • 2019 PARENT/GUARDIAN CONSENT FOR CAMPERS UNDER THE AGE OF 18
  • PARENT GUARDIAN CONSENT:
    I declare that I
    1. Have legal custody of the herein named child applying to Camp Mishewah.
    2. Declare that the herein named child is in good physical and emotional health and amenable to Camp Mishewah authority.
    3. Will ensure that the herein names child will leave all electronic devices at home while at Camp Mishewah.
    4. Am responsible for payment of fees and any other expenses incurred by my herein named child.
    5. Declare that the herein named child attending Camp Mishewah is covered by their provincial health plan or equivalent medical insurance.
    6. Declare that I have submitted my child’s up-to-date medical information and agree with the following Consent to Treatment statements that are on the Health & Medical Form:
    • To the best of my knowledge, my child is in good health. If my child becomes exposed to any serious/infectious diseases within four weeks of attending camp, I will notify the Camp Directors.
    • In case of surgical emergency and I am not available for consultation, I hereby give permission to the physician selected by the Camp Director or designate to hospitalize, secure proper treatment for and to order injections, anesthesia, or surgery for my child.
    • I give permission for the Camp Nurse or trained personnel to administer stock medications that are approved by a physician in case of minor injury, and/or illness during my child’s stay at Mishewah.
    • I also give permission for the Camp Nurse or trained personnel to provide Standard First Aid to my child as appropriate.
    • I give permission for the Camp Health Nurse or trained personnel to administer medications provided by me as per indicated on the submitted health form.
    • I give permission for Epinephrine to be administered to my child in case of an anaphylactic (life-threatening) reaction.
    • I agree that all the information given on the Camper Health & Medical Form is correct and complete.
    • By signing, I agree to pay all health related expenses and treatments not covered by the Provincial Health Plan (ie. lice treatments, medications, dressing supplies, casts, etc.)
    7. Give permission to Camp Mishewah to use photographs of the herein named child for promotional material.*
    8. Give permission for the herein named child to be transported by bus or personal vehicle to offsite locations for hiking, canoeing, and excursions or to be taken to the hospital/clinic for medical treatment if necessary.
    9. Give permission for the herein named child to participate at Camp Mishewah, its facilities, programs and activities. All physical programs and activities have risks and I understand there are physical risks and hazards inherent in any program or activity. I am allowing my child to participate and understand that I am exposing my child to inherent risks and hazards. I agree to accept all risks and hazards and be responsible for any injury or other loss which may occur during the participation of my child. I understand that reasonable precautions shall be taken to ensure the health and safety of the herein named camper.

    * If you do not want photos of your child used, please send an explanation to jeanette@ecmcamps.ca along with a recent photo of your child. Thank you.


    If camper is 18 years of age or older, he/she may sign below.

  • / /
  • FOR SCAMPS & CHAMPS AND JUNIOR TEEN CAMPERS PLEASE PROCEED TO THE NEXT PAGE AND COMPLETE THE INFORMATION FOR COUNSELLORS







  • FOR ALL CAMPERS, PLEASE PROCEED TO THE HEALTH & MEDICAL FORM AND SUBMIT ALONG WITH THIS FORM IN ORDER TO COMPLETE THE REGISTRATION PROCESS. THANK YOU.

  • 1 / 2