Family Camp Registration

      Fields with * are required


Which Camp?*


First Name*
Last Name*
Mailing Address*
Postal Code*
Street Address (if different)
Family Email


Phone - home*
Phone - work
Phone - cell

Emergency Contact:

Emerg. Contact Name*
Phone - emergency*
Phone - emerg. 2
Relationship to family*


In case of serious accident or illness every person must be covered by the BC Health Plan or an equivalent policy.
Describe Medical Plan if other than provincial.

Name - Gender - Birthdate - Health Care #
Please list in chart format - for each member
Family Doctor*
Doctor Phone*
Provide family information as applicable
Allergies? Dietary? Limitations affecting camp?
Need-to-Know information as applicable
Tendency to be bullied, aggressive or other behaviours?



Our First Aid department generally stocks basic over-the-counter medications. The list below is only a sample of the more common medications we would normally carry. (Please use this information to answer the next question.)

  • Antihistamines:  Benadryl, Loratadine
  • Cough and cold:  throat lozenges, cough syrups (no codeine), cold capsules
  • Analgesics:  Acetaminophen, Ibuprofen, (also under brand names ie: Tylenol, Advil)
  • Digestion:  Tums, Pepto Bismal, Gravol
Please list any over-the-counter meds to which
you oppose being given to a family member.
Prescriptions currently being taken by a family
member which we may need-to-know?


Any medications turned into our First Aid must be in the original container. Prescriptions may only be used by the person for whom they are prescribed. Camp Policy regarding first aid treatment can be found on our website in the parents information section.


Note that prices are the same whether you use a cabin or bring your own tent or RV. Note that cabin space is limited, and by allowing RVs we are able to increase our capacity for family camps.

We will be needing a cabin.
We will be bringing an RV or tent.
We would like to use one of camp's tents.


We require the guardian's signature and sensitive need-to-know information.

This part is required and must be signed as is:

Guardian Authorization:    Read before signing.

I recognize that, while Sagitawa staff will care for my child in a responsible manner, accidents and discomforts may still occur. I'm fully aware of the types of activities my child may be involved in, and I accept that these activities often come with a degree of spontaneity and risk.  Should injury require emergency treatment which would be delayed by efforts to contact me, I authorize the Director or First Aid Attendant to begin medical treatment and inform me as soon as possible.

I will provide Camp Sagitawa with "need-to-know" information to assist them to care for the well-being of my child and other children.

I consent to Sagitawa's purposes for gathering and using the information I provide.

Registration only accepted if above waiver is signed with box already marked as Yes. If you disagree
then do not sign form.

The next 3 waivers are optional - but helpful to camp.

Change to 'No' if you disagree.

Optional Waiver 1:    
I give Sagitawa permission to send me brochures and newsletters or emails about upcoming camps for the next two years.

Note: We also remove from mailing lists on request. This is not a 2 year commitment.
Optional Waiver 2:
I grant permission for Sagitawa to use pictures of my family in cabin pictures, camper journals and DVDs.
Optional Waiver 3:
I further permit Sagitawa to use pictures of my family in their brochures, displays, printed material or on our web pages (without names attached).
I have read the camp waivers.*
Date of signing
Print Full Guardian Name*
Signature (clicking shows intent to sign)*


Please enter full amounts from charts into the corresponding areas below. When making your payment, minimum deposit is $60 or full amount if less.

Camp policy on cancellations
Camp reserves the right to hold half the deposit for cancellations more than two weeks before the event and the whole deposit after the 2 weeks.

The cost associated with registering is based on cabin space. All family camp fees are well below cost, and even if we have full camps, we still run below cost as a non-profit service to the community. When you register, we reserve your cabin space. If you cancel near the beginning of the camp, it becomes too late to advertise and fill the vacancy. We are less concerned about the minimal costs associated with pre-ordered food and credit card processing fees.

If you have to cancel, please know that there are some conditions where we are willing to waive the cancellation fee. When requesting that the fee be waived, please ask to speak to the Camp Director.

2017 Dates Camp
May 12-14
Single Parent Family Camp $80 / family
Jun 29-Jul 2 Pastor's Family Weekend no charge / accept donations
Aug 18-21 Sagitawa Family Retreat $50 /person, $25 (age 4-13), $200 Max Family


Camp Fee (figure total from above chart)*
Tuck & Crafts (optional - suggest $10-30)

Thank you for considering a tax deductible donation.

Optional Contribution Amount
Designation for above contribution
How shall we send receipt?
Details for other method

Space will be held once payment is made.

I will send payment via email transfer - (email below)
I will call camp with Credit Card info see below
I will send a cheque or money order (see below)