Intermediate Ranch Camp Extended (ages 12-15)

Camper's First Name *

Last Name *

Box Number (Address) *

City *

Province *

Postal Code *

Phone (please do not include any spaces) *

Email *

Gender (required) *

Birthday (required) *

Age *

Parents/Guardians Names *

Dad's Work Number

Mom's Work Number

How many new friends are you bringing to MLBC?

What are their names? *

Cabin Mate Preference (one name please)

Medical Insurance Numbers *

What Province is your medical insurance? *

Health Concerns (please include pertinent medications, food allergies, etc.)

This is the ___ child I am registering *

Name of 1st Child Registered *

Name of 2nd Child Registered *

Name of 3rd Child Registered *

Name of 4th Child Registered *

Name of 5th Child Registered *

Emergency Contact Name *

Emergency Contact Phone *

Parent / Guardian Permission Form *

In case of emergency, I understand every effort will be made to contact me. In the event that I cannot be reached in an emergency situation, I hereby give permission to licensed emergency and health care personnel to provide treatment, services and transport necessary to maintain the health of my child. In the event medication, medical advice, treatment and/or equipment are required, I agree to accept financial responsibility for fees in excess of provincial and or private medical insurance. I agree that the information on this form may be disclosed to such emergency and health care personnel. In the event of illness, accident, emergency, or any other circumstance requiring medical treatment, such treatment may be procured for the participant without legal or financial obligation to Madge Lake Bible Camp and One Hope Canada. All known health issues of my child have been stated to the camp. I will notify the camp if my child is exposed to any infectious diseases prior to arriving at camp. I have read and understood the terms of this agreement and BY ALLOWING MY CHILD(REN) to participate in the camp, I am voluntarily agreeing to abide to these terms. I confirm that the participant [my child] is physically and mentally able to participate in all activities of the camp, unless specifically indicated otherwise in writing. Madge Lake Bible Camp reserves the right to request any participant to withdraw from their camp if the participant is not acting in an appropriate and responsible manner.

Photographs *

Photos may be taken of your children. They may be used in any and all camp promotional material including the sharing of photographs and videos with ministry partners of One Hope Canada. If you do NOT want photos taken of your children, please let us know when you drop them off for registration!

Understood the terms of this agreement *

I have read and understood the terms of this agreement and BY ALLOWING MYSELF / MY CHILD(REN) to participate in the camp, I am voluntarily agreeing to abide to these terms. I confirm that the participant [myself or my child] is physically and mentally able to participate in all activities of the camp, unless specifically indicated otherwise in writing.

Permission to connect

We count it a privilege that you are sending your son or daughter to spend the week with us at camp this summer. During a week of camp, we look forward to many great friendships being formed! We have an amazing summer missionary team, and they love to stay connected with their campers throughout the year to hear how they are doing and answer any questions they may have about the topics discussed during chapel session and cabin devotionals. As part of our child and youth protection policy (www.insafehands.ca) we are committed to honouring you as a parent/guardian and to asking your permission before any contact occurs between campers and our missionaries (Facebook, Twitter, phone calls, etc.). Our missionaries would be honoured to be able to continue to stay involved in your child or youth’s life after camp. Please initial to indicate whether or not you give permission to our missionaries to stay in contact with your son or daughter. If you wish to discuss this further, please contact the camp director by phone or email (please see camp website for contact information). If you wish to withdraw your permission, please contact the camp office immediately to notify the camp director.

Permission for Aquatic Adventures

At some point during the week, we take the entire camp to Aquatic Adventures at Ministik Beach. By checking this box, you are giving us permission to sign their waiver on your behalf. If you do not check this box, your child will not be able to go. To read their waiver, go to https://www.saskaquaticadventures.com/waiver.

I have read *

I have read this Parent / Guardian Permission Form, fully understand its terms and the risks I am assuming by signing it, and sign it freely and voluntarily.

Informed Consent and Assumption of Risk *

IN CONSIDERATION of being permitted to participate in any way at Madge Lake Bible Camp, (hereafter known as ministry point) operated by One Hope Ministries of Canada , I acknowledge, understand, and agree: 1.) Participation in activities could result in possible personal injury. Despite precautions taken by the ministry point, accidents and injuries may occur. By signing this form, I assume all risks related to the use of any and all spaces used by the ministry point. 2.) To release from responsibility, the ministry point, including all missionaries, full-time and part-time, paid or volunteer, and the facilities used from any cause of action, claims, or demands now, and in the future that might arise out of the participant’s participation in activities at the ministry point or from the physical risks associated with the activities. 3.) I accept all risks relating to such activities including personal injury such as: cuts, sprains, scrapes, bruises, fractures, broken bones, concussions, death, or any personal property damage/loss, which may occur on the camp premises. I understand these risks and will not hold the ministry point liable for any such injury. 4.) Furthermore, I agree to obey all ministry point rules and take full responsibility for my behavior in addition to any damage I may cause to the facilities utilized by the ministry point.

I have read *

I have read this Informed Consent and Assumption of Risk Agreement, fully understand its terms and the risks I am assuming by signing it, and sign it freely and voluntarily.

This is to certify that *

This is to certify that, I, as parent/guardian with legal responsibility for this participant, have read this Informed Consent and Assumption of Risk Agreement, fully understand its terms, and that I have given up substantial rights by signing it, and sign it freely and voluntarily.

Would you like your child to attend Aquatic Adventures? *

Yes ($15)

No

We take all of our campers to Aquatic Adventures once a week. If you would like your child to attend, please review the waiver by clicking this link. Checking "yes" in the box will add a $15 charge to your fee.

We have several discount programs as well as camp sponsorships available. For more information, go to
https://madgelakebiblecamp.ca/camp/info-for-parents

Optional donation to Madge Lake Bible Camp

Coupon

Amount

$

Discount Amount

$

Payment processing fee

$

Gross amount

$

Deposit Amount

$

Payment Type

Payment Method - we would like to go paperless as much as possible. If you can, please pay via E-transfer or Credit Card. *

Will Mail in Payment/Pay at Camp E-Transfer Square Card Payment

Credit Card Number*

Expiration Date*

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Card (CVV) Code*

Card Holder Name*

Credit or debit card*

Captcha*

Please enter the text you see in the image in the text box for captcha validation

Individual Registration

Emergency Contacts

PARENT/GUARDIAN PERMISSION FORM

INFORMED CONSENT & ASSUMPTION OF RISKS

Payment Information