Community Roots Day Camp in Mahone Bay • Anglican Diocese of Nova Scotia and Prince Edward Island

Date & Time

6 July, 2026 9:00 am - 10 July, 2026 3:00 pm

10 out of 10 remaining tickets available

Type

Price

Quantity

Campers

10 Remaining

Price
$0.00

Quantity

Campers 0

Camper Basic Information

First Name *

Last Name *

What do they like to be called? *

How old is the camper? *

Our camp is for campers ages 6 to 12. Would you like to request an exception for this child to participate?

Yes

Our camp is for ages 6 to 12. Would this individual be interested in volunteering at camp instead?

Yes

Please do not complete this registration form.

Please complete the rest of this registration form. We will review the registration and get back to you with a decision within a few days.

Please email campadmin@nspeidiocese.ca for details about how to register as a youth volunteer.

Please do not submit this registration form.

Camper Birthdate *

Have they been to a daycamp before? *

Yes

Contact Information

What email address should we use to get in touch with you? *

Cell Number

Home Number

Complete mailing address

Permissions

Can we contact you by text message through our registration system to share information about camp? *

Yes

Can we share your child's name and contact information with the church hosting the camp so that they can stay in touch with you? *

Yes

Can we share your name and contact information with other youth and family ministry programs in the Diocese of Nova Scotia & Prince Edward Island so that they can get in touch with you about other events?

Yes

Camper Health, Medical, and Personal Support Information

Healthcard Number and Expiry Date *

Does your child have any physical, mental, emotional or behavioural conditions that may impact their participation in camp? *

Yes

Please give us some details about how to best support your camper:

Does the camper receive in-class support during the school year? *

Yes

Tip: This may include anything in an IPP such as an education assistant, shortened instructional times, etc. Please note that we don't have the capacity to provide one-on-one support for campers, but are happy to work with families to find ways to support their camper's participation in our program.

Please describe the support that they reeive:

Are there any restrictions on their physical activities? *

Yes

Please describe them:

Do they take any medication? *

Yes

Please list the medication(s), dose(s), frequency and purpose of the medications:

Do they have any allergies or dietary restrictions? *

Yes

Please list any allergens and the severity of the reactions and any dietary needs:

Is there anything else that you think we should know about your child? *

Emergency Contact Information

This is who we will call first. Even is this information is already included elsewhere on this form, please put the details of the primary emergency contact here.

Emergency Contact Name *

Relationship to Camper *

Phone Number *

Backup Emergency Contact

This is who we will call if we can't contact the first person.

Emergency Contact Name

Relationship to Camper

Emergency Contact Phone Number