The Camper Application and Medical Forms
Loon Bay Camp, 2007

Please detach this form and send along with the $25 registration fee* to: 

Registrar: Ruby Hancott

P.O.Box 15

Campbellton, NL.

A0G 1L0

(Please remember to fill out the medical form below which must be sent with the application form)

Please make cheques or money orders payable to Loon Bay Camp.

Child’s Name:______________________________________________________ 

Birth date:________________________ 

Male  □              Female  □ 

Date of Camp child will be attending: ________________________________ 

Complete Mailing Address:_____________________________________________________

________________________________________________________________

Home phone#:____________________

Parent work #_____________________

Cell phone #______________________ 

Local Church:__________________________________________________________

Child’s Camping experience in years:___________

*Registration fee is deducted from total camp cost

Medical Form

Camper’s Name:_______________________________________________________

MCP#:_________________________________

Please list any health concerns or special needs that your child has:________________________

__________________________________________________________________________________

_______________________________________

Food/Drug Allergies:_____________________________________________________________________________________

Any special dietary requirements? Please list :

_______________________________________________________________________________________________________

Please list the medications that your child will be bringing to camp: ___________________________________________________

____________________________________________________________________________________________________________
Note : A letter from your doctor must accompany all medications brought to camp indicating what the medication is for and when it is to be administered.

Has your child had a tetanus booster within the last ten years? Yes  □         No □

If your child should be restricted from any camp activities, please list which ones:

___________________________________________________________________________________________________________

Camp staff will do their utmost to contact parents/ guardians if an emergency arises. Any medical cost incurred by the camp is to be reimbursed by parent/guardian.

In case of emergency, I hereby give permission to the attending physician to make medical decisions for my child.

parent/guardian’s signature   _______________________________________ _______________                                                   Date:___________________________________

Emergency Contact Name:__________________________

Contact Number:___________________________________