Camper Registration | Hope Valley Day Camp

Camper #1 Information

Camper #1 First Name

Camper #1 Last Name

Gender

Birth Date

Age Group

Camper #1 Which Camp?

Transportation

If possible, team with

Name of sibling at camp

Medical Info / Special Notes (If medication is required at camp, please include Medication Name, Dose and Time to be taken)

I give Hope Valley Office Staff permission to administer the medication described above to my child(ren).

Please fill out even if child has attended previously. (ALLERGIES, PRESCRIPTION MEDICATIONS, BEHAVIOURAL OR SPECIAL CONSIDERATIONS, ETC); Please understand that if your child requires any special supervision at school, you must provide the same at camp, and we reserve the right to send campers home at our discretion.

Does your child require a one to one worker? Please note: If they have this support at school, they will need this support at camp. You will need to arrange to bring your own worker with them to camp. The worker must fill out this Police Check and send it to info@hopevalley.ca.

Camper #2 Information

Camper #2 First Name

Camper #2 Last Name

Gender

Birth Date

Age Group

Camper #2 Which Camp?

Transportation

If possible, team with

Name of sibling at camp

Medical Info / Special Notes (If medication is required at camp, please include Medication Name, Dose and Time to be taken)

I give Hope Valley Office Staff permission to administer the medication described above to my child(ren).

Camper #3 Information

Camper #3 First Name

Camper #3 Last Name

Gender

Birth Date

Age Group

Camper #3 Which Camp?

Transportation

If possible, team with

Name of sibling at camp

Medical Info / Special Notes (If medication is required at camp, please include Medication Name, Dose and Time to be taken)

I give Hope Valley Office Staff permission to administer the medication described above to my child(ren).

Camper #4 Information

Camper #4 First Name

Camper #4 Last Name

Gender

Birth Date

Age Group

Camper #4 Which Camp?

Transportation

If possible, team with

Name of sibling at camp

Medical Info / Special Notes (If medication is required at camp, please include Medication Name, Dose and Time to be taken)

I give Hope Valley Office Staff permission to administer the medication described above to my child(ren).

Camper #5 Information

Camper #5 First Name

Camper #5 Last Name

Gender

Birth Date

Age Group

Camper #5 Which Camp?

Transportation

If possible, team with

Name of sibling at camp

Medical Info / Special Notes (If medication is required at camp, please include Medication Name, Dose and Time to be taken)

I give Hope Valley Office Staff permission to administer the medication described above to my child(ren).

Family / Contact Information:

Parent / Guardian Full Name(s)

Address

Unit #

City

Postal Code

Phone 1

Cell?

Texts Ok?

Phone 2

Cell?

Texts Ok?

Email Address

Alternate Contacts: (In case we can't reach you)

Alternate Contact #1 Name

Phone

Cell?

Texts Ok?

Relationship

Does this person have permission to pick up my child?

Alternate Contact #2 Name

Phone

Cell?

Texts Ok?

Relationship

Does this person have permission to pick up my child?

Alternate Contact #3 Name

Phone

Cell?

Texts Ok?

Relationship

Does this person have permission to pick up my child?

Notes:

I/We, named above, undertake and agree to indemnify and hold blameless the Program Personnel, Hope Valley Day Camp, its Leaders and Board from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Hope Valley Day Camp as well as of any medical treatment authorized by the supervising individuals representing the camp. This consent and authorization is effective only when participating in or traveling to events of Hope Valley Day Camp.
I agree to not send my child to camp with any cold or flu symptoms.
I hereby give my consent for my child to attend Hope Valley Day Camp and participate in the programs including but not limited to, archery, slip and slide, the small climbing wall (no harness required) and swimming in the pool. In case of a medical emergency, I give permission to the physician selected by Hope Valley Day Camp to hospitalize and administer proper treatment for my child(ren).
I hereby give permission to have my child’s photograph or video used in any promotional material Hope Valley Day Camp may produce including on Facebook, Instagram, Website and Brochures. No Camper names are ever used.
Hope Valley is not responsible for lost or stolen items. Items that are found will be stored in the Lost and Found area. Items will be kept until September 30. Any unclaimed items that are still in the Lost and Found by September 30, will be donated and given away.
Hope Valley will not be held responsible for a child who has been given permission to walk home from the bus stop, if the parent/guardian is not present.
I have read this entire form & fully completed all sections and I further understand that an incomplete registration form may be returned to me at the address given & that my child will not be registered until Hope Valley confirms the registration.

Parent / Guardian Signature:

× Clear

Swimmer 1
Current Ability:	Is new to swimming lessons, or has turned 5 years of age and has completed Preschool A, B, or C. This level focuses on the fundamentals of swimming.
Similar To:	YMCA Otter and Red Cross Level 1
Swimmer 2
Current Ability:	Can submerge, perform front and back floats, glides and kicking, as well as swim front crawl for 5 m in a PFD. Has turned 5 years of age and completed Preschool D or E.
Similar To:	YMCA Seal and Red Cross Level 2/3
Swimmer 3
Current Ability:	Can tread water for 15s, perform front, back and side flutter kick, whip kick in the vertical position, swim front and back crawl for 10m each, and swim 4 x 5m flutter kick interval training. Successfully completed Swimmer 2.
Similar To:	YMCA Dolphin and Red Cross Level 4
Swimmer 4
Current Ability:	Can tread water for 30s, perform front, back, and side flutter kick, whip kick on back, swim front and back crawl for 15m, and swim 4 x 15m flutter kick interval training. Successfully completed Swimmer 3.
Similar To:	YMCA Swimmer and Red Cross Level 5
Swimmer 5
Current Ability:	Has completed the Canadian Swim to Survive standard (roll into deep water, tread 1 min, swim 50m), whip kick on front, breaststroke arms, front and back crawl for 25m, and can swim 4 x 25m front or back crawl interval training. Successfully completed Swimmer 4.
Similar To:	YMCA Star 1 and Red Cross Level 6
Swimmer 6
Current Ability:	Can perform eggbeater kick, front and back crawl for 50m, breaststroke for 25m, and two interval training workouts: 4 x 50m front or back crawl, and 4 x 15m breaststroke. Successfully completed Swimmer 5.
Similar To:	YMCA Star 2 and Red Cross Level 7

Online Camp Registration

Camper #1 Information

Camper #2 Information

Camper #3 Information

Camper #4 Information

Camper #5 Information

Family / Contact Information:

Alternate Contacts: (In case we can't reach you)

Notes:

Parent / Guardian Signature: