CAMP
TEMISKAMING

Camp Temiskaming Registration Form

Camper Information

Please submit one form per camper

Full Name

Gender

Date of Birth

Year

Month

Day

Health Card Number and Version Code

Family Doctor

Parent/Guardian Information

Full Name

Address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Phone

Home Church (if applicable)

Emergency Contact (other than parent above)

In the case that we are unable to reach you in an emergency, please provide the name and number of someone we can contact.

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Name

Emergency Contact Phone

Health Information

Are vaccinations up to date?

Date of last tetanus shot:

Are corrective lenses required?

Contact lenses worn?

The program may include swimming, hiking, kayaking, etc. Does the applicant suffer from any physical or emotional disorder that would prevent them from participating fully in this program?

If so, please state full particulars

Does the camper have any special dietary needs/requirements? (i.e. allergies, vegetarian, etc)

Does the camper have any allergies? If so, please state the type of reaction and treatment required.

Has the camper ever been a victim of bullying?

Any additional details we should be aware of?

Please provide details of usual treatment/medications should any of the above conditions occur.

Are there any family issues we should be aware of? If so, please provide details below.

Briefly describe the camper's temperament.

What are the camper's favourite hobbies?

Please provide details of chronic conditions or recent illness of which we should be made aware.

Please list any medications which the camper is bringing with them. These MUST be clearly labelled and given to staff upon arrival.

Do you have any special instructions for staff regarding this camper's care and needs at camp?

Please select the week of camp you are registering for (ages as of Dec 31, 2026):

Mixed (Co-Ed) Camp I - July 12 - 18, 2026 (Ages 8-12) (only boys spots remaining)

Mixed (Co-Ed) Camp II - July 19 - 25, 2026 (Ages 12-15)

Mixed (Co-Ed) Camp III - Aug 9 - 15, 2026 (Ages 8-12)

Total camp fees to be sent with registration:

Minimum deposit of $150 (non-refundable) to secure spot. Remainder ($325) must be received by June 1, 2026 or spot will be forfeited.

$450 early-bird registration if full fee received before May 15, 2026

$475 for full fee received before June 1, 2026

$500 for late registrations after June 1, 2026

Payment Options

Payment can be sent by e-transfer to camptemiskaming@outlook.com or via cheque mailed to Camp Temiskaming c/o PO Box 543, Englehart, ON P0J1H0

Financial Assistance

If you require financial assistance, please contact the registrar before April 30, 2026 to apply for a bursary.

Late Registration:

Late registrations may not be accepted. If a late registration has not been confirmed by July 1, 2026, please contact the registrar at camptemiskaming@outlook.com & DO NOT attend camp without confirmation.

Conditions of Attendance - Medical and Photo Release

I acknowledge and understand the following:

1) The parents/guardians submitting this registration have legal custody of named camper. Conditions of custody must be communicated in writing, with photocopied court orders regarding visitation rights where applicable, to the attention of the Camp Director.

2) While due care is taken for the health and safety of the campers, in the event of sickness or accident, Camp Temiskaming, including the camp committee and all staff are hereby released of any liability

3) In the event that a camper requires medical treatment beyond the first aid measures available at Camp Temiskaming, the parent(s)/guardian(s) will be notified and charged with any additional expense arising from special care

4) In the case of medical emergency, I give permission to the physician selected by the Camp Director to hospitalize, secure treatment, and to order injection, anesthesia or surgery for the child named in this registration form.

5) I give Camp Temiskaming permission to use any image or likeness of the camper in promotional material.

6) The Camp Director reserves the right to dismiss any camper who is a hazard to the safety and rights of others, or who has, at the discretion of the Director, rejected the reasonable expectations of Camp Temiskaming. Camp fees will not be refunded.

7) I give Camp Temiskaming permission to take the camper on supervised activities that may, from time to time, occur off the immediate Camp property.

By signing below you are agreeing to these conditions of attendance.

Parent/Guardian Full Name:

Date picker

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.