Winnipeg Beach Day Camp Registration Form

Welcome to our new registration form! We are trying to cut down on our use of paper and are going digital!

The questions that have a red star next to them are required information.

If you have any questions regarding our new format please email us at winnipegbeachdaycamp@hotmail.com

Child Name (1) *

First Name Last Name

Birth Date *

Month Day Year

Age *

MHSC # *

6 digets

PHIN # *

9 Digets

Swimming Level *

Has your child taken swimming lessons? *

Child Name (2)

First Name Last Name

Birth Date

Month Day Year

Age

MHSC #

6 digets

PHIN #

9 Digets

Swimming Level

Has your child taken swimming lessons?

Child Name (3)

First Name Last Name

Birth Date

Month Day Year

Age

MHSC #

6 digets

PHIN #

9 Digets

Swimming Level

Has your child taken swimming lessons?

Parent/Guardian Name (1) *

First Name Last Name

Parent/Guardian Name (2)

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Primary Phone Number *

Area Code Phone Number

Secondary Phone Number *

Area Code Phone Number

E-mail *

Name *

First Name Last Name

Relationship to Camper *

(Ex: Grandparent, Friend, Relative, etc.)

Phone Number *

Area Code Phone Number

Physician Name *

First Name Last Name

Phone Number *

Area Code Phone Number

Medical Concerns *

Please indicate if your child has allergies, asthma, or other medical concerns

*

Attendance

Week 1: July 6th -10th

Week 2: July 13th - 17th

Week 3: July 20th - 24th

Week 4: July 27th - 31st

Week 5: Aug 4th - 7th

Week 6: Aug 10th - 14th

Week 7: Aug 17th - 21st

10 Day Pass

Please leave us a comment about your attendance if necessary

Release and Waiver for *

Camper's Name

I understand that participation in outdoor camp activities
involves potential risk to my child (children) and I assume that risk on my child’s
(children's) behalf. Acknowledging this fact, and in consideration of you accepting my
child’s (children's) registration for any and all sessions attended by my child in the 2020
camp season, I hereby for myself, my heirs, executors, administrators or anyone else who
may be entitled to claim on my or my child’s (children's) behalf, covenant not to sue, and
hereby waive, release and discharge the Winnipeg Beach Day Camp Inc. and its officers
and directors and all their agents, employees, assigns or anyone else acting for or of any
kind or nature whatsoever arising out of, or in the course of my child’s (children's)
participation in the camp, other than a result of gross negligence of officers, directors or
employees of the camp. This release and Waiver extends to all claims of every kind of
nature whatsoever, foreseen and unforeseen, known or unknown. I acknowledge having
read this waiver and by signing below I am stating that I understand and accept its terms
and conditions.

Signature *

Clear

By signing below, I agree to allow my child's/ children's picture(s) to be featured in this
or future editions of the Winnipeg Beach Day Camp website, Facebook, or other such
advertising for the camp. If I do not sign, I am not providing such permission.

Signature

Clear

Date *

We have 3 methods of payments:

1. E-transfer fees to winnipegbeachdaycamp@hotmail.com

2. Snail Mail a Cheque or Cash

Mail to Director

944 Queenston Bay, Winnipeg, MB, R3N 0Y2

Drop-off to the camp office

3. Pay On-site with cash or a cheque

What is your method of payment *

E-transfer Snail Mail On-site

Winnipeg Beach Day Camp Registration Form

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION:

Emergency Contact

MEDICAL INFORMATION

Dates

Winnipeg Beach Day Camp - Release Wavier

Payment