RIVERSIDE UNITED CHURCH

 

 

First Name _________________________________________________  Last Name ____________________________

 

Gender  M ____     F ______                                 Date of Birth ____________________________________________

 

Address_______________________________________   Home Phone _________________ Cell _________________

 

Parent/Guardian ____________________________________________________________________________________

 

Riverside United Church Dates:   Aug 3     Aug 4       Aug 5      Aug 6

Our goal of this new and exciting program is t9o bring ‘camp’ out into the community.  During the week of Gesstwood day camp, campers will experience lots of fun and exciting activities.  Our week will be filled with tons of games, creative crafts, nature activities, drama, Christian education, singing and lots of fun!  Specialized activities and creative themed days are incorporated with traditional activities for a well-rounded camp experience.

 

Campers are asked to bring a packed lunch each day.  To ensure everyone’s safety, please bring nut-free lunches and snacks.

 

CAMPER MEDICAL INFORMATION

 

Ontario Health Card # ____________________________________________________________

 

Allergy Information

Food ____________________________________________________________________________

Drugs ___________________________________________________________________________

Other ____________________________________________________________________________’

              Please indicate bee, wasp, hornet, mosquito bites/stings)

 

How severe is the allergic reactions? _______________________________________________

 

Does your child have an Epi-Pen?     YES ___________       NO _____________

 

Are there any special medical conditions we should be aware of?

 

Was your child exposed to any communicable diseases in the last 3 weeks?  If so, please explain:

 

 

 

 

Is your child currently enrolled in the Riverside United Church Sunday School?         Yes                   No

 

 

For RUC Administrative use only:

 

$10           $20