CAMPER APPLICATION FORM

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CAMPER INFORMATION

Upload Picture of Applicant *
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Last Name *
First Name *
Middle Initial
Address
Age *
Date of Birth (dd/mm/yyyy) *
Sex *
Current Grade *
Camper Role *
Patient OFF treatment for cancer since (dd/mm/yyyy) *

In order to give you the very best time at camp, we would like to know a little bit about you and your interests:

Do you have any hobbies? What are they?
What are your favorite games?
What are your favorite sports?
What are your favorite crafts?
Have you been to camp before? Where and when?
Was camp fun? Why or why not?
What would you most like to do at camp?
If you have been to Camp Circle O Friends before, please tell us how we can improve it:
Is there anything you would like to tell us that we did not ask?
Please rate your swimming ability *
Swimming Level Achieved
What is your T-Shirt size? *
You will come to camp on a bus. Which bus will you be taking? *

DEADLINE FOR APPLICATIONS IS FRIDAY MAY 14, 2027

 

Camp Circle O’ Friends is committed to ensuring that every eligible camper has the opportunity to attend camp. If you are able to contribute the camp fee ($40.00), you may choose to submit payment via E-transfer. If you require sponsorship for your child to attend camp, please select the appropriate option below.

Would you like to pay the camp fee?*
I would like to pay the camp fee now
My child requires sponsorship

The camp registration fee is $40.00 per camper. Payment can be submitted via e-transfer to the following email address: cfriends@sasktel.net

When sending your payment, please include your camper’s full name along with “Registration 2027” in the memo line so we can accurately process your payment.

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REGISTRATION CONSENT FORM

I,

wish to register

for Camp Circle O' Friends Inc. on June 10-13, 2027.

Consent to Participate

I give my child permission to participate fully in all activities of the Camp Circle O Friends Inc. program (unless otherwise specified on the MEDICAL HISTORY FORM). I agree that any change(s) will be communicated in writing to the Camp Director.*
YES
NO

Consent FOR TRANSPORTATION

I agree to allow Camp Circle O Friends Inc. staff to transport my child to and from camp and during any camp activities on sites for the duration of camp.*
YES
NO
I agree to allow Camp Circle O Friends Inc. staff to transport my child to Regina General Hospital in Regina, SK or Jim Pattison Childrens Hospital in Saskatoon, SK in case of a medical emergency.*
YES
NO

Consent TO MEDICAL CARE

I give Camp Circle O Friends Inc. permission to provide medical care for my child if required.*
YES
NO

Consent for release

I hereby agree to indemnify all and save harmless organizers and volunteers with respect to any claim, which could be made on account of the above named person's attendance at camp.

Date (dd/mm/yyyy) *
Signature of Parent/Guardian *
Clear
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PARENT/GUARDIAN INFORMATION

Last Name *
First Name *
Address
Parent/Guardian best contact number with area code *
Parent/Guardian email address *
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RELEASE FORM

Authorization to Reproduce Physical Likeness

I,

of

in the province of Saskatchewan hereby give Camp Circle O' Friends Inc. all rights to of every kind and character whatsoever in and to all work heretofore done and all poses, acts, plays, and appearances heretofore made by me for it as well as in and to the right to use photographs, either still or moving, for promotional purposes. Photographs may be used on promotional material including and not limited to print materials, multi-media presentation, the Camp Circle O' Friends Inc. website and social media accounts, or the Children's Oncology Camping Association website.

Date (dd/mm/yyyy) *
Signature of Guardian *
Clear
Signature of Witness *
Clear
Name of Guardian *
Name of Witness *
Address
Phone number
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CAMPER MEDICAL HISTORY FORM - 2027

Last Name *
First Name *
Middle Initial
Age *
Date of Birth (dd/mm/yyyy) *
Sex *
Current Weight *
Current Height *

ALLERGY

Sask. Health Insurance Number *
Does the camper have any allergies?
Yes, he/she does
No, he/she does not
Environmental
Severity
Treatment Given
Animals
Severity
Treatment Given
Insects
Severity
Treatment Given
Foods
Severity
Treatment Given
Medications
Severity
Treatment Given
Other
Severity
Treatment Given
Does the camper carry his/her own epi-pen? (please send pen if required) *
YES
NO

MEDICATIONS

Please list any medications your child will need to receive at camp.

DO NOT PLACE MEDICATIONS IN DOSETTES

Please send all medications (both prescription and over-the-counter) in their original containers.
Medication
Dose
Times
Special Requirements
Medication
Dose
Times
Special Requirements
Medication
Dose
Times
Special Requirements
Medication
Dose
Times
Special Requirements
Medication
Dose
Times
Special Requirements
Medication
Dose
Times
Special Requirements
Medication
Dose
Times
Special Requirements
Medication
Dose
Times
Special Requirements

Please indicate if camper experiences or has experienced any of the following problems:

Headaches *
Please give details
Convulsions/Seizures *
Please give details
Fainting Spells *
Please give details
Vision Problems *
Please give details
Hearing Problems *
Please give details
Breathing Problems *
Please give details
Heart Problems *
Please give details
Blood Clotting Problems *
Please give details
Stomach/Bowel Problems *
Please give details
Skin Problems *
Please give details
Frequent Infections *
Please give details
Diabetes *
Please give details
Emotional Problems *
Please give details
Hyperactivity *
Please give details
Nightmares *
Please give details
Sleepwalking *
Please give details
Bedwetting *
Please give details
Walking Problems *
Please give details
Other

Please indicate if camper has had the following illnesses:

Chicken Pox *
Date (dd/mm/yyyy)
Timing in Relation to Cancer Tx *
Shingles *
Date (dd/mm/yyyy)
Timing in Relation to Cancer Tx *
Measles *
Date (dd/mm/yyyy)
Timing in Relation to Cancer Tx *
Mumps *
Date (dd/mm/yyyy)
Timing in Relation to Cancer Tx *
Rubella (German Measles) *
Date (dd/mm/yyyy)
Timing in Relation to Cancer Tx *

Please indicate if camper has had the following immunizations:

MMR *
Date (dd/mm/yyyy)
Timing in Relation to Cancer Tx *
Meningitis *
Date (dd/mm/yyyy)
Timing in Relation to Cancer Tx *
Tetanus *
Date (dd/mm/yyyy)
Timing in Relation to Cancer Tx *
Chicken Pox (Varivax) *
Date (dd/mm/yyyy)
Timing in Relation to Cancer Tx *
Hepatitis B *
Date (dd/mm/yyyy)
Timing in Relation to Cancer Tx *
Covid Vaccine *
Number of Doses
Dates Received
Has the camper had any major illnesses or operations?
Yes
No
Please explain (include things like VP shunts, rods, pins, prosthesis, etc.)
Has the camper menstruated?
Yes
No
Not Applicable
Has she been told about it?
Yes
No
Is her menstrual cycle normal?
Yes
No
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