Camper Registration

Camp Overview

Who can be a camper?: Children going into Sr. Kindergarten (5 years old) up to Grade 6 (11 years old) in fall of 2023

Location: St. George Parish (1164 Commissioners Rd. W., London, ON)

Dates:

- August 8-11 (4-day week)

- August 14-18

- August 21-25

Time: 9AM-4PM

Cost per week of camp: $75 per camper, up to 4 campers. $50 per camper, after 4 campers

Before & After Care:

- Before care: 8:30AM-9AM

- After care: 4PM-4:30PM

- Cost: $10/day

*Bursaries available; contact us for more information

Springbank Catholic Family of Parishes
Day Camp Registration

Camper Information

First Name

Last Name

Birthday

Grade in the fall

Gender

Health Card Number

Physician Name

Physician Phone Number

Medical Information (allergies, medical conditions, etc.)

T-Shirt Size

Youth Small

Youth Medium

Youth Large

Adult Small

Week(s) of camp

August 8-11

August 14-18

August 21-25

During the day, campers may be split into groups based on age. Campers may request to be in a group with one or two other people. If your camper would like to request a group member(s), please list their name(s) below and the Springbank Camp staff will do their best to accomodate your request. If campers are not the same age, it is unlikely that they will be grouped together.

Child 2

*All campers on this form must be under your legal guardianship (i.e. you are their parent, court-appointed guardian, etc.)

First Name

Last Name

Birthday

Grade in the fall

Gender

Health Card Number

Physician Name

Physician Phone Number

Medical Information (allergies, medical conditions, etc.)

T-Shirt Size

Youth Small

Youth Medium

Youth Large

Adult Small

Child 3

*All campers on this form must be under your legal guardianship (i.e. you are their parent, court-appointed guardian, etc.)

First Name

Last Name

Birthday

Grade in the fall

Gender

Health Card Number

Physician Name

Physician Phone Number

Medical Information (allergies, medical conditions, etc.)

T-Shirt Size

Youth Small

Youth Medium

Youth Large

Adult Small

Before/After Care

Before and after care will be provided each day of camp. Each day (before AND after care) is $10, up to a total of $50 for the week.

Week 1 (August 8-11)

Before Care

Tuesday, August 8

Wednesday, August 9

Thursday, August 10

Friday, August 11

After Care

Tuesday, August 8

Wednesday, August 9

Thursday, August 10

Friday, August 11

Week 2 (August 14-18)

Week 3 (August 21-25)

Parent/Guardian Information

* The Parent/Guardian will also act as the Emergency Contact.

First Name

Last Name

Relationship to Camper

Primary Phone Number

Secondary Phone Number

Email (All camp communications will be sent via email)

Street Address

City

Postal / Zip code

Region/State/Province

Authorized Pickup List

* At least one Primary Pickup Person must be a legal parent/guardian. Individuals who are not listed as primary pickup individuals will be asked for government-issued ID upon arrival.

Primary Pickup Person #1

Relation to Camper

Primary Pickup Person #2

Relation to Camper

Secondary Pickup Person #1

Secondary Pickup Person #2

Payment Information

How many weeks of camp?

1 week of camp ($75)

2 weeks of camp ($150)

3 weeks of camp ($225)

How many days of before/after care?

Total: (Number of Weeks of Camp x $75) + (Number of days of before and after care x $10)

Cheque: Made payable to St. George parish; brought to or mailed to the office at St. George Parish

E-Transfer: To stgeorge@dol.ca

Cash: Brought to the office at St. George Parish

Payment Options

*Payment must be submitted by 7 business days after registration in order to guarantee your camper's spot(s). Please indicate which payment method you wish to use.

Acknowledgements and Waiver

Waiver

*Please download and complete the waiver form by clicking on the "PDF" button to the left of this text. Children who do not have waivers will not be able to participate in camp. Waivers must be filled out by the camper's legal parent/guardian. Once you have completed the form, save it on your computer.

Upload Waiver

Waiver

*Please upload your completed waiver by clicking on the "Upload Waiver" button to the left of this text. Waivers must be filled out by the camper's legal parent/guardian.

I hereby acknowldge that all information provided on this form is correct and that I have signed the attached waiver form as a legal parent/guardian of my child(ren).

I give permission for my child to travel on foot to Springbank Park.

I authorize the use of any photos taken over the duration of camp for non-profit promotional purposes in the future.

Parent/Guardian Name

Date

Parent/Guardian Signature

Camper Registration

Springbank Catholic Family of Parishes Day Camp Registration

Springbank Catholic Family of Parishes
Day Camp Registration