summe r day camp registraon – 2020 · day camp at lambton centre with the current covid-19...

Summer Day Camp Registra�on – 2020 Charitable Registra�on: 107594269

Camper Informa�on

Camper Name:____________________________ ▢ Male / ▢ Female

Street:_____________________________________________________________________________

City:_____________________________ Province:_____________ Postal Code:________________

Birthdate (DD/MM/YYYY):__________________________________ Age at Camp:_______________

Family Informa�on

Parent / Guardian 1

Full Name: __________________________

Address: ____________________________

____________________________________

____________________________________

Phone: ______________________________

Cell:________________________________

Email:_______________________________

Parent / Guardian 2

Full Name: __________________________

Address: ____________________________

____________________________________

____________________________________

Phone: ______________________________

Cell:________________________________

Email:_______________________________

Emergency Contact

Emergency Contact

Full Name: ___________________________

Rela�on: ____________________________

Phone: ______________________________

Cell:________________________________

Family Physician

Full Name: ___________________________

Phone: _____________________________

Office Hours: _________________________

Camper Health Card: ___________________

6602 Lakeshore Rd. Lambton Shores ON N0N 1J7 - P: 519.786.5663 - F: 519.786.6686 - www.lambtoncentre.com of 6


Camp Sessions (please check each session the camper plans to a�end.

Session Name Ages Dates Fee ▢ WEEK 1 5-13 July 6 th – 10 th $225 ▢ WEEK 2-SPLASH DAY CAMP #1 5 – 13 July 13 th – 17 th $225 ▢ LEADER IN TRAINING 15-17 July 13 th – 17 th ** $450 ▢ WEEK 3 5-13 July 20 th – 24 th $225 ▢ WEEK 4 5-13 July 27 th – 31 st $225 ▢ WEEK 5 5-13 Aug. 3 rd – 7 th

$225

▢ WEEK 6-SPLASH DAY CAMP #2 5-13 Aug. 10 th – 14 th $225 ▢ WEEK 7 5-13 Aug. 17 th – 21 st $225

**OUR LEADERS IN TRAINING PROGRAM CONSISTS OF A TOTAL OF THREE WEEKS. THE ONE LISTED PLUS TWO ADDITIONAL WEEKS TO BE DETERMINED TOGETHER BY THE LIT COORDINATOR**

Day Camp at Lambton Centre

With the current COVID-19 pandemic Lambton Centre has been working closely with Lambton Public Health to develop a day camp program that can provide an exci�ng outdoor camp experience for young campers in a way that is as safe as possible. Providing a safe camp experience is a coopera�ve effort shared by camp staff, campers and parents/guardians. Therefore, we need you and your child to agree to follow the following rules.

Campers:

● Campers will need to respect the need for physical distancing as directed by counsellors. ● Campers must always stay with their cabin group. ● Campers will not share any items with other campers in their group. This will include sunscreen, insect

repellent, water bo�les, brushes, towels or any other item. ● If a camper is not feeling well they must advise their counsellor who will follow-up with the camp health

care provider.



● Although campers will not need to wear a mask all the �me it is recommended that they have a mask that they can use if needed.

Parent/guardian:

● You must provide a daily screening of their camper prior to leaving home. This screening will include the child’s temperature and checking for any of the following symptoms, cough, shortness of breath, sore throat, runny nose, nasal conges�on, headache, and a general feeling of being unwell.

● If your child has any symptoms or they have been in contact with anyone with symptoms, they must be kept home.

● If there is any concern that your child may have COVID-19 they are to no�fy the Summer Camp Director and the Lambton Public Health.

● Provide your camper with their own supplies of sunscreen, insect repellent, towels, a water bo�le that are labelled and not to be shared (even between siblings).

● Upon arrival at the camp, you will remain in your vehicle and complete the drop off screening with a Senior Staff member. The camper will then proceed to their cabin group if they pass the screening.

● If a camper becomes ill at camp the camper will be isolated at the Farm House with Lambton Centre Staff who will contact the emergency contact and arrange for the child to be picked up immediately.

● To facilitate the screening process at drop off and pick up you will be given a specific �me for drop off and pick up.

A full descrip�on of the Lambton Centre’s Infec�on Management Protocol can be found on our website.

I understand the risk of sending my child to camp. I agree that I have read the above statement and will follow all of the rules. I have explained the rules to my child. I understand that if the rules are not followed my child could be asked to stay home. _____________________________________ _____________________ Parent / Guardian Signature Date

T-Shirt Size

All campers will receive a FREE T-Shirt with their registra�on. In order for your child to be guaranteed a certain size, please fill out the form below to indicate the size of the shirt for your child. If you have any concerns regarding the fabric of the T-Shirt, please contact the Centre and speak with the Summer Camp Director.

▢ Adult XL ▢ Adult L ▢ Adult M ▢ Adult S ▢ Youth XL ▢ Youth L ▢ Youth M ▢ Youth S ▢ Other:____ Addi�onal Informa�on how many years, including this one, your child has a�ended Lambton Centre Summer Camp: _________



Payment Informa�on

Cost

Total Camp #1: _______________________

Total Camp #2: _______________________

Total Camp #3: ________________________

Sub Total: _________________________

13% HST: _____________________________

Total: ________________________________

Payment

Please Check Method of Payment

▢Cheque ▢Cash

▢VISA ▢ MasterCard

Card #: _______________________________

exp. __________

Cardholder Name:___________________

Signature: ____________________________

Sign up for Our E-Mails Lambton Centre would like to keep in touch with opportuni�es and events throughout the year. If you are interested in any informa�on related to any of the following topics, please check the box and we will add your email address to our contact list. Should you decide to have your email removed from any of our contact lists we would be glad to do so at your request.

▢ I hereby give consent to Lambton Centre to add my email address(es), listed in the Family Informa�on sec�on or as listed below, to their email contact list for the purpose of marke�ng. I acknowledge that I may remove myself from this list at any �me by emailing Lambton Centre and indica�ng so. Personal informa�on will not be given out to individuals outside of the Lambton Centre organiza�on without your consent.

If you would like to receive updates from Lambton Centre through our newsle�ers please check the types of informa�on you would be interested in. Email address: _________________________________________________________

▢ Summer Camp Informa�on ▢ Newsle�ers ▢ Fundraising Events ▢ United Church Events

▢ Outdoor Educa�on ▢ Retreat opportuni�es ▢ Virtual Camp ▢ Other Interests:__________________



How did you hear about us

▢ Brochure ▢ Friend/Family ▢ Newsle�er

▢ Internet Search ▢ Radio Ad. ▢ Community Event

▢ Our Website ▢ School Field Trip ▢ Road Sign

▢ Social Media ▢ Other: ____________

Camp Policies, Condi�ons and Authori�es Lambton Centre provides a safe and nurturing environment for our campers, family and staff. Respect and trust are some of the most important elements of the camp experience. We ask that before your campers arrive at camp, they are aware that they must respect other campers, staff, camp policies, and the camp facility. Lambton Centre reserves the right to remove any camper from the program should their behaviour pose a physical or emo�onal threat to any camper, staff member or the camp property, without refund of registra�on fees. Lambton Centre is a smoke, alcohol and drug-free facility, and use of these substances will result in immediate dismissal from the camp program without refund. Lambton Centre’s summer camp program strives to be “gadget-free”. Campers are not permi�ed to bring cell phones, personal computers, iPods or related devices to camp. Gadgets will only be u�lized by staff for camp purposes. Lambton Centre culinary staff offer a wide assortment of meal op�ons that cater to the needs of alterna�ve diets. Should your camper require any unique dietary items, please let us know on your health form. If you have ques�ons or concerns regarding alterna�ve diets at camp, contact the Summer Camp Director. Lambton Centre recognizes the importance of each camper’s unique medical needs. All medica�ons must be submi�ed to the camp Health Care Provider at the �me of drop off. No camper will be permi�ed to carry any personal medica�ons, with the excep�on of Epipens, Inhalers, or others at the discre�on of the Summer Camp Director and Health Care Staff. By submi�ng this applica�on, the parents/guardian agree for and on behalf of themselves and the camper that any photograph or video was taken of the camper by camp personnel or others authorized by the Summer Camp Director may be used without charge by Lambton Centre for any promo�onal material; including brochures, slideshows, videos, websites or social media networks; unless a wri�en le�er is submi�ed that states otherwise. Almost there All that needs to be done now is to submit this registra�on form, you can do so by faxing it to 519-786-6686, By emailing it to [email protected] or by mailing it to 6602 Lakeshore Road, Lambton Shores, Ontario N0N 1J7. If you have any troubles or ques�ons regarding the submission of this form, please contact the office at 519-786-5663

I hereby give consent for______________________________ to a�end Lambton Centre and confirm that their health is suitable for camping ac�vi�es. I authorize Lambton Centre to refer to the below camper to medical authori�es on my behalf. Parent/Guardian signature_____________________________________ Date:____________________



HEALTH FORM Camper Informa�on

Emergency Informa�on (required again)

Emergency Contact 1

Full Name: _________________________________

Rela�on: ___________________________________

Phone: _____________________________________

Cell: _______________________________________

Emergency Contact 2

Full Name: _________________________________

Rela�on: ___________________________________

Phone: _____________________________________

Cell: _______________________________________

Please list all medica�on/health care products brought to camp:

Dedica�on/Product Used to treat Administra�on instruc�ons/Details

Is Lambton Centre able to give your child Advil/Tylenol/Gravol/Benadryl at the discre�on of the Health Care

Provider? ▢ - Yes / ▢ - No ▢ - Yes, but give this number a call first: _____________________


Parent/Guardian Signature _______________________________ Date: ________________

LC Health Care Staff ____________________________________ Date: ________________

summe r day camp registraon – 2020 · day camp at lambton centre with the current covid-19...

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