Please fill out the following form and submit

Parent Name *

First

Last

Youth Name *

First

Last

Youth Nick Name

What is the preference name to use.

Youth Date of Birth *

Age of youth as of April 1st.

My child learns best from

Youth General Medical History

Respiratory problems? Asthma? *

Yes
No

Dizziness or fainting episodes? *

Yes
No

Does your child see a medical or physical specialist of any kind? *

Yes
No

Does your child have any physical, cognitive, sensory or emotional condition that would require a special teaching environment? *

Yes
No

Has your chlld had treatment, counselling or hospitalization with a mental health professional? *

Yes
No

Is the child allergic to any foods? *

Yes
No

Are there any dietary restrictions? Please specify *

None
Vegetarian
Vegan
Other

Has your child had any allergic reactions to insects, bee/wasp stings, or medications resulting in hives, swelling or difficulty breathing? *If appropriate please bring a personal supply of epinephrine, and know how to use it. *

Yes
No

Any other allergies? *

Yes
No

Please explain any "Yes" above in detail

Authorization and Terms

Please carefully read the following text and check the terms below to confirm your acceptance to the terms of Moose Family Camp Resort

My child has my authorization to participate in the activities of the Moose Family Camp Resort programs. *

Yes
No

I guarantee that my child will listen to and carry out Moose Family Camp Resort and staff instructions and will not act irresponsibly, or beyond own ability. *

Yes
No

I allow taking photography and videos of my child that can be used for Moose Family Camp Resort advertising *

Yes
No

I authorized Moose Family Camp Resort to apply judgement in regards to medical assistance in the event of an accident, injury, or illness if they are unable to contact the parent/guardian. *

Yes
No

I shall accept full financial responsibility for any damage or loss of any equipment or items while it is within your child's possession or control *

Yes
No

I understand that if my child show symptoms of being ill or having Covid-19, parents/guardian will be asked to pick-up the student immediately. *

Yes
No

Comment or Message

What would you like to have us do?

I agree to the terms above and will use this as my signature. *

First

Last

Date Signed

Register your child for Moose Outdoor English Club.

Please fill out the following form and submit

Youth General Medical History

Authorization and Terms

Information

About Camp

Reservations

Activities

Information

Reservations

Activities

About Camp