First Name

Last Name

Date of Birth (MM-DD-YY) Select The year first

Phone Number

Address

Email Address

Home Church (if applicable)

Parent / Guardian's Name

Emergency Contact Name

Emergency Contact Phone Number

Health Card Number

Does your child require a EA at school? Does your child require a EA at school? Yes No

Allergies / Medical Information

Is there anyone your child would like to be in a cabin with?

- Select Payment - - Select Payment - *E-Transfer : blccamp@hotmail.comCheque / Cash at drop-offLocal Church SupportNot sure yet

Media Release: During the week we will take photographs of camp activities involving campers. Does Big Lake Camp have your permission to use photographs that include your child for publication, reproduction, and advertising purposes? Media Release: During the week we will take photographs of camp activities involving campers. Does Big Lake Camp have your permission to use photographs that include your child for publication, reproduction, and advertising purposes? Yes No

I will not hold Big Lake Camp liable for any injuries incurred on the camp property or during any camp activity, regardless of circumstances.