RKY Camp – Ontario, Canada

SCHEDULE

FORMS

ONLINE 2010
SUMMER CAMP REGISTRATION

ONLINE 2010
WINTER CAMP REGISTRATION

SUMMER 2010 REGISTRATION FORM

IMPORTANT:

Please use one form per person.

You have 2 ways to register:

Fill our out Online Registration form below,
or Download our Registration form here.

Step 1: Choose one session only.

SESSIONS (Ages should be as of Dec 31, 2010)	JULY 2 to 14	JULY 17 to 29	AUGUST 2 to 14	AUGUST 17 to 29	FEES plus tax
Junior Camp (7-8yrs.)	Session 1 July 2-7	Session 2 July 9-14		Session 3 Aug 2-7	$500 6 days
Youth Camp (9-10 yrs.)	New 6 Day Session August 9-14				$500 6 days
Youth Camp (8-12 yrs.)	Session 1	Session 2	Session 3	Session 4	$1,005 2 weeks
Senior Camp (13-15 yrs.)	Session 1	Session 2	Session 3	Session 4	$1,012 2 weeks
L.I.T. (15-16 yrs.)	Session 1	Session 2	Session 3	Session 4	$1,155 2 weeks
C.I.T. (16-17 yrs.)	Session 1 July 2-29		Session 2 August 2-29		$1,586 1 month

Step 2: Camper Contact Information - Please fill out in full

First Name:

Last Name:

Age as of Dec. 31, 2010:

Birth Date:

DD/MM/YY

Last Grade Completed:

Grade:

Gender:

Male

Female

Street Address 1:

Street Address 2:

City:

Province:

Postal Code:

Phone:

Family or Parent Email:

Please note that this email will be used to send home session updates from camp during your camper’s stay.

Cabinmate's Request:
(One name only)

We make every effort to honour one mutual request for campers of the same age or grade. Cabinmate requests are NOT guaranteed. Due to cabins space, requests to exclude a particular camper from your child's cabin cannot be honoured. If you have questions about these policies, please contact the Camp Director.

Do Both Parents Live at Home?

Yes

If No, Which parent has legal custody?

Mother

Father

Mother's First Name:

Mother's Last Name:

Mother's Home Telephone:

Mother's Work Telephone:

Place of Employment:

Mother's Occupation:

Father's First Name:

Father's Last Name:

Father's Home Telephone:

Father's Work Telephone:

Place of Employment:

Father's Occupation:

Who will pick your child up on the last day of camp?

Emergency Contact Name:

Emergency Contact Phone.:

Relationship (to camper):

Step 3: Camper Medical Information -Please fill out in fill

Health Insurance Co. Name :

Policy Number:

ONTARIO DRUG BENEFIT #:
(if subscriber)

Provincial Health Card Number:

Expiry Date (Quebec Only):

DD/MM/YY

Doctor's First Name:

Doctor's Last Name:

Doctor's Phone:

Are your child’s immunizations up to date?

Yes

Immunization details (if necessary):

What is your child allergic to?

Please list all foods, antiibiotics, drugs, or insect stings if applicable

Does your child carry an EPIPEN?

Yes

Please list any prescription drugs and dosage your child will bring to camp:

please do not send nonprescription drugs or vitamins to camp

Has your child had any of the following?

Asthma	Hepatitis
Behaviour Disorder	Diabetes
Sinus Trouble	Kidney Trouble
Epilepsy/Fainting	Severe Stomach Ache
Hay Fever	Heart Condition
Chicken Pox	Other:

Is your child:

vegetarian (no meat, poultry, or fish)

vegan (no meat or dairy products)

partial vegetarian: eats poultry

partial vegetarian: eats fish

Other:

Camp medical staff are able to provide over the counter
drugs for common ailments. Please indicate any drugs or medication you do not wish for us to provide:

Drugs provided can include acetaminophen, ibuprofen, cold & cough medicine, Gravol, and hay fever/allergy edication.

If child is female, has she menstruated?

Yes

If "No", has she been told about it?

Yes

If "Yes", is her menstrual history normal?

Yes

Please list any restrictions your child has that could affect his/her camp experience or about which we should know:

for example: physical, emotional, or medical

Step 4: Prior Camp History

Number of years at RKY Camp:

Number of years at another camp:

If attended another camp, what is their camp name?

What is your child's normal bedtime?

Is she/he a bedwetter?

Yes

Please describe habits/routines around bedtime in your home:

What is your child's outlook on their camp experience this year?

Very interested and excited

Somewhat interested

Somewhat apprehensive

Very concerned or afraid

Do you expect your child to be homesick?

Yes

If so, what might help to cheer her/him up?

My child makes friends most easily with:

own age

younger

older

all ages

Have there been any significant family changes in the last year?

Yes

exampe: divorce, death, birth, family move

If Yes, please describe:

Please describe her/his eating habits and your wishes in this regard:

Will your child bring to camp any eyeglasses, orthodontic equipment, etc.?

Yes

If yes, please provide necessary directions to staff:

Please describe any special expectations you may have of the camp program or staff:

Please list any RKY Camp activities in which you do not wish your child to participate:

Step 5: Fees and Payments

***All payments must be received in full by May 1, 2010***

Select your Session Fees:

Junior Camp (6 days) $500

Youth Camp (6 days) $500

Youth Camp (2 weeks) $1,005

Senior Camp (2 weeks) $1,012

Leader-In-Training (one month) $1,155

Counsellor-In-Training (one month) $1,586

Tuck Shop Amount:

RKY Camp's Tuck Shop sells camp gear, souvenirs,
pop, chips, chocolate bars, and candy. Campers visit
the Tuck Shop every other day. If you wish to provide an
amount for your child to spend, payment can be made
now or on the first day of camp. More information on the
2010 Tuck Shop will be available later. A typical amount
for a Tuck Account is $50.

If you wish, your child's leftover Tuck money can be donated to the RKY Campership fund:

	Yes
	No, please refund the leftover Tuck money at the end of the season.

The RKY Campership Fund subsidizes camp fees for as many as 15% of RKY Campers each season who would not otherwise be able to attend. Donations over $10 will be receipted for tax purposes. (Charitable Registration # 119121341RR0001)

Does your child have any brothers or sisters attending camp at the same time?

Yes

If so, please provide names and ages:

Family Discount:

Children from the same family receive $40 off each registration after the first child

Deposit, if already paid:

I would like to make a donation to help SEND A KID TO CAMP!

Yes

RKY Camp is a registered charity. We provide over $40,000 each year to help send kids to camp. Please consider making RKY Camp your charity of choice. All donations over $10 will be receipted for tax purposes.
(Charitable Registration # 119121341RR0001)

If yes, please enter the donation amount:

$10

$25

$50

$100

Other amount:

Please deduct the following donation amount from my credit card:

Once

each month, beginning on the this date:

Payment Method:

Cash

Cheque

VISA

Mastercard

Other Payment:

Credit Card number:

Expiry Date:

Name on Card:

By clicking on the Submit button, I confirm that I have authorized to make payments and that I have read the Terms and Conditions.

Terms and Conditions:

Financial Assistance
All RKY Camp Programs are open to anyone, regardless of ability to pay. To apply for financial assistance, simply contact the camp office for an application form.

Cancellations
We are happy to refund all camp fees, except the nonrefundable deposit, for all cancellations made before May 1, 2010, or if we are able to fill your child’s spot. If not, the following schedule will apply. For cancellations between May 1 and May 28, 2010, we will refund 50% of the camp fee. Cancellations made on June 1, 2010, or later are nonrefundable. All cancellations must be made in writing. Any cancellations due to medical reasons will be dealt with on a case-by-case basis.

Taxes
Payments made before May 1st , 2010 are subject to 8% taxes, after May 1st , 13% HST.
Taxes are subject to change with the implementation of HST on July 1st , 2010. Any changes will be determined by information received from the government of Ontario.

***All payments must be received in full by May 1, 2010***
Payments may be made by cash, cheque, VISA or Mastercard.
We accept payments in full and postdated payments. If you require more flexible payment terms, simply contact the Camp Director or the Camp Registrar. Should you wish to set up a payment plan please contact the registrar.

BOTH CUSTODIAL parents must agree:

I desire my child,to participate in the full camp program and all activities unless I advise you otherwise in writing. I agree that, having taken such precautions as in your discretion are deemed advisable, you shall not be held responsible for any accident or
sickness affecting my child, or for loss or damage to her/his personal property.
I understand that, should my child, in the judgement of the Camp Director, become a hazard to her/himself or to others at camp, s/he may be sent home without refund.
To the best of my knowledge, my child is in good health. I will notify the Camp if my child is exposed to an infectious disease during the three weeks prior to arriving at camp. In case of surgical emergency, and I am not immediately available for consultation, I hereby give permission to the physician, selected by the Camp Director, to hospitalize, secure proper treatment for and to order injections, anaesthesia or surgery for my child.
I understand that photographs and video recordings taken at camp may be used for promotion. I have read and understand the payment terms and the cancellation policies explained above.