Camp registration forms Campers - print and fill out
- A waiver suitable for their age ( see tabs )
- Camp registration form
- Medical information sheet
Registration for Day Camps
Rider Information
First Name: Middle Last name:
Week(s) of camp you are registering for _________________________
Half or Full Day Camp
Amount Paid: ____________
Birth Date: Height : Weight:
Mailing Address:
Parent/guardian Contact Name :
Work /or cell# : Telephone:
Rider Medical Information Health Card #:
Physician Name: Tel#:
Emergency Contact Name and phone number : (other than above)
Please advise of any medical conditions, ie. asthma, allergies, ADD, other. Do you carry and Epi- pen. Have you or your child received any psychological/psychiatric/family therapy in the last 12 months? Are you or your child currently taking any medication? Please note that all medications should be forwarded to the Camp Director with full doctor's instructions. Under NO circumstances should a child carry his/her medication unsupervised.
Does your child suffer from back problems? Yes /No (circle one)
Does your child suffer from neck pain? Yes / No( circle one )
Are you/your child pregnant ? Yes /No (circle one) If you become pregnant at a later date I agree that I will tell my instructor.
Please give any details of any heatlh problems that you may affect your riding.______________________________________________________
______________________please include a note with medical form.
Medical/Release Form The rider/camper and/or his/her parent(s) and/or guardian(s) hereby acknowledge the risks and hazards inherent in riding and working around animals, not to be limited to: horses, chickens, dogs and cats and agree to assume all responsibility and risk of bodily injury or damage to property and further agree to hold harmless and indemnify Corner Stone Farm and its owners, employees, volunteers, agents, and representatives from all claims for any bodily injury to persons or damage to property arising out of or resulting from the camper's use of Corner Stone Farms’ premises or use of horses at or from Corner Stone Farm , as a rider, groom or spectator or otherwise in any type of Corner Stone Farms organize, sponsored, supported or endorsed activity, whether on Corner Stone Farm premises or elsewhere, and including transportation provided Corner Stone Farm or the individuals or organizers referred to herein. The camper and his/her parent(s) and/or guardian(s) do hereby consent to any medical examination, treatment or medical services that may be rendered to said camper under the general or specific instructions of any physician or hospital. It is understood that this consent is given in advance of any specific diagnosis or treatment. The camper and the undersigned parent(s) and/or guardian(s) agree to assume responsibility for payment of all fees for doctors, hospitals, ambulances and/or other medical charges reasonably and necessarily incurred. Insurance is the responsibility of the rider/camper and/or his/her parents. The camper and his/her parent(s) and/or guardian(s) do hereby consent that photos/images of the camper/rider may be used in Corner Stone Farm’s articles and advertisements without payment or remuneration to that said camper/rider.
I agree to inform Cathy Colwell and/or Corner Stone Farm if any of the above details change. I agree to abide by all the rules of Corner stone Farm while I am a client of the above establishment. Deposit and camp fee agreement deposit of 50% of the camp fee is to be attached with your registration form. Any incomplete forms will not be accepted. If you have any questions about filling out the forms please contact Cathy.
Please note that the balance of camp fees must be received no later than week before the first day of your child's camp session. Camp fees are non-refundable after this time.
Cheque made out to Cathy Colwell
Should you need to withdraw your child from camp, arrangements can be made to credit your child for an alternate camp session during the current season (subject to availability and discretion of camp director). All deposits are non-refundable.
Signature of rider:__________________________________
Print name: ______________________________________
Date and Signature :____________________________________
Parent or Guardian signature if client is a minor : _______________________________________
Please submit this form with your camp registration letter. Paper work to be done prior to arrival at Corner Stone Farm Camp (address listed below)
CORNER STONE FARM CAMP
2891 Highway 15 Kingston Ontario K7L 4V3
Health History form for Children, Youth, and Adults Attending Camps
Dates attending camp _____________________________
The information on this form is not part of the camper or staff acceptance process, but is gathered to assist us in identifying appropriate care. Any changes to this form should be provided to camp health personnel upon participant’s arrival in camp. Provide complete information so that the camp can be aware of your needs
Full Name of
Camper ___________________________________
Birth Date ________________
Age at camp _____________ Home address :
Health Card number of participant :
Gender:
___ M ___ F
Custodial parent/guardian- Print named in full :
Phone
Home address
Business address:
Phone
Second parent or guardian or emergency contact :
Address
Phone
Business address:
Phone
If not available in an emergency, notify ________________________________
Relationship
Phone
Address
Insurance Information : Is the participant covered by family medical/hospital insurance? ____ Yes ____No If so, indicate carrier or plan name ____________________________Group #____________________ Photocopy of front and back of health insurance card must be attached to this form.
Important—initial each- must be complete for attendance*
___Parent/guardian Authorizations: This health history is correct and complete as far as I know, and the person herein described has permission to engage in all camp activities except as noted. I hereby give permission to the camp to provide routine health care, administer prescribed medications, and seek emergency medical treatment including ordering x-rays or routine tests.
___I agree to the release of any records necessary for treatment, referral billing, or insurance purposes.
___I give permission to the camp to arrange necessary related transportation for me/my child. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp to secure and administer treatment, including hospitalization, for the person named above. This completed form may be photocopied for trips out of camp.
Signature of parent or guardian :
Printed name _______________________________________________________ Date : ______________________
ALLERGIES List all known. Describe reaction and management of the reaction.
Medication allergies (list)
________________________________________( use a second page if needed to give a complete list of Medications )
Food allergies (list)
__________________________________________( use a second page if needed to give a complete list of Allergies)
Other allergies (list)—include insect stings, hay fever, asthma, animal dander, etc.________________________________( use a second page if needed to give a complete list of Medications / allergies)
MEDICATIONS BEING TAKEN - To be placed in a Zip Lock Bag with Clear Label on OUTSIDE
Please list ALL medications (including over-the-counter or nonprescription drugs) taken routinely. Bring enough medication to last the entire time at camp. Keep it in the original packaging/bottle that identifies the prescribing physician (if a prescription drug), the name of the medicine, the dosage, and the frequency of administration.