Register – Step 1 of 2 | Spina Bifida and Hydrocephalus Association of Alberta

Camper Application

Name *

First

Last *

Last

Email *

Adult t-shirt size *

Mailing Address *

City *

Province *

Postal Code *

Country *

Home Phone *

Gender *

Male

Female

Date of birth *

Age at time of camp: *

Last grade completed: *

EMERGENCY INFORMATION - It is important that we be able to reach at least one of the emergency contacts on a 24-hour basis for the duration of the camp.

Parent/Guardian #1

Name *

Relationship *

Home Phone *

Work Phone

Cell Phone *

Other Phone

Email *

Address *

City *

Province *

Postal Code *

Parent/Guardian #2

Name *

Relationship *

Home Phone *

Work Phone

Cell Phone *

Other Phone

Email *

Address *

City *

Province *

Postal Code *

Other Information

Please describe the assistance or support required by the camper in each of the following activities. If the camper is independent, please indicate.

Eating/Drinking: *

Showering: *

Dressing: *

Transfers in/out of wheelchair: *

Please describe any other information we should know to help the camper have the best time possible at Camp Freedom (anxiety, feares, bedtime routines, etc.)

Optional Hoodie Order

We offer personalized hoodies for sale to our campers. They are perfect for sitting around the campfire or to put on after an evening of swimming. The navy hoodies have “Camp Freedom” embroidered on the left chest, and your first name on the sleeve. Both lettering is done in white thread. The cost including GST is $40 (select your payment option during the checkout process).

Order Hoodie? *

Yes

Name on Hoodie? *

Adult Hoodie size

Camp Freedom Participation Agreement

Name of camper: *

Address: *

Date of Birth *

This camper wishes to participate in the activities at Camp Freedom and as a condition of participation, the camper’s parent or legal guardian agrees to the following:

1. I am aware that Camp Freedom provides activities such as water sports, ropes course and other physically active games that could result in stress or injury. I waive any action or claim against Camp Freedom, the SBHANA, Camp HeHoHa, volunteers and employees of these organizations for any accident or injury.

2. I agree to pay any costs incurred by Camp Freedom in the proper care of the Camper over and above the camper fees. (Transportation in the event of an early return, medication, ambulance services, damage to property.)

3. I consent and authorize such medical and or hospital care as deemed necessary by the medical authority of Camp Freedom.

4. I give permission to Camp Freedom and the SBHANA to use my child’s photograph and/or video recording for future publications of promotional material and newsletters without monetary compensation.

By typing your name here and submitting this form you consent to the terms of the liability release as stated above.

Parent/Legal Guardian Signature: *

Relationship to camper: *

Phone (Home): *

Phone (Work):

Today's Date

Register – Step 1 of 2

Camper Application

Parent/Guardian #1

Parent/Guardian #2

Medical Information & Level of Care

Bowel Routine

Other Information

Optional Hoodie Order

Camp Freedom Participation Agreement