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

Applying discount...

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

Have they been to a daycamp before? *

Yes

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

Complete mailing address

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

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 Name *

Relationship to Camper *

Emergency Contact Name

Relationship to Camper

Emergency Contact Phone Number