Mom & Kids Registration

Adult Info

Friday, July 29th through Tuesday, August 2nd, 2022
Adults $288, Kids 5 & up $168, Kids 4 & under FREE!

Preferred Arrival Date*

Preferred Departure Date*

Name*

Address*

Street Address City Province Postal Code

Home Ph #*

Work Ph #

Cell Ph #

Email*

Doctor’s name*

Doctor's Phone Number

Emergency Contact*

Name	Phone	Relation

Second Emergency Contact*

Name	Phone	Relation

List medical concerns*

List all medications*

Allergies, or special diet*

Where did you hear about Camp Wohelo? been before, a friend, an ad, a brochure( where did you get it?) or other (please be specific)*

Requested cabin mates

Children’s info

Please list children with you from youngest to oldest.

First Child's Name*

Birth date (d/m/y)*

Age*

Sex*

Doctor’s name*

Doctor's Phone Number

Is there anyone restricted from seeing this child?

List all medical conditions, mental, emotional, physical and behavioral challenges that your child may have including, skin conditions, asthma, bed-wetting, epilepsy, diabetes, heart conditions, hyper-activity, etc.*

List all medications*

Allergies, or special diet*

Date of last Tetanus shot (enter date or comment)

Second Child's Name

Birth date (d/m/y)

Age

Sex

Doctor’s name

Doctor's Phone Number

Is there anyone restricted from seeing this child?

List all medical conditions, mental, emotional, physical and behavioral challenges that your child may have including, skin conditions, asthma, bed-wetting, epilepsy, diabetes, heart conditions, hyper-activity, etc.

List all medications

Allergies, or special diet

Date of last Tetanus shot (enter date or comment)

Third Child's Name

Birth date (d/m/y)

Age

Sex

Doctor’s name

Doctor's Phone Number

Is there anyone restricted from seeing this child?

List all medical conditions, mental, emotional, physical and behavioral challenges that your child may have including, skin conditions, asthma, bed-wetting, epilepsy, diabetes, heart conditions, hyper-activity, etc.

List all medications

Allergies, or special diet

Date of last Tetanus shot (enter date or comment)

I give permission for myself and the children to be photographed/videotaped for use in marketing material*

Yes
No

A copy of Health cards for each person must be attached to this form, or be brought with you to camp.

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.

All medication, prescriptions and over the counter, (OTC may include gravel, Tylenol, Benadryl, etc.) must be brought by the camper, be in the original container and given to the camp medic upon arrival at camp.

In case of medical emergency I hereby give permission to the physician selected by the camp staff to hospitalize and/or secure treatment for myself and/or my child/children as named above. I understand that in an emergency myself and/or my child/children may be transported in a personal vehicle and I hereby waive our rights and the rights of my child/ren to any claim against Camp Wohelo, it’s employees or volunteers.*

Yes

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