Camp Registration Form

      Fields with * are required  (if you have no information for a required field, use N/A)

Off Season Camps - Dates and Fees

Camp Dates Group

Total Fee

  Spring     Break    Camps   Unbound! Mar 23 - 25 gr 4-7 $100
Prospective Cabin
Leader Training
Mar 23 - 28 15+ yrs $50
CORE Mar 25 - 28 12 yrs - adult $210
Fall Retreat Pushing the Limit Oct 5 - 7  Jr High $100




Camp Attending..*
Please put me in a cabin with (friend 1)
Please put me in a cabin with (friend 2)
If attending with youth group, name of group?


First Name*
Initial(s) required for CORE
Last Name*
Mailing Address*
Postal Code*
Street Address (if different)
Date of Birth (mm/dd/yy)*
Grade (entering)*
Camper Email
Parent Email


Parent Name(s)*
Phone - home*
Phone - work
Phone - work extension
Phone - cell
Phone - other

Emergency Contact:

Contact Name*
Relationship to camper*
Phone - emergency1*
Phone - emergency2


In case of serious accident or illness every person must be covered by the BC Health Plan or an equivalent policy.

Care Card (Health Number)*
Describe Medical Plan if other than provincial
Family Doctor
Doctor Phone
Immunizations up to date?*
Year of Last Tetanus Shot



Please use this comprehensive list of our over-the-counter First Aid medications to answer the question below. Also see our First Aid Policy online.

  • A current Epi-pen, but campers or staff with Epi-pen prescriptions should bring their own.
  • Antihistamines: Diphenhydramine (Benadryl), or non-sedating, Loratadine (Claritan)
  • Cough and cold: Throat lozenges, cough syrups (no codeine), and cold capsules such as Advil Cold or Tylenol Cold.
  • Analgesics: Acetaminophen, Ibuprofen, (also under brand names ie: Tylenol, Advil)
  • Digestion, Stomach & Bowel: Tums, Pepto Bismal, Gravol, Ginger Ale
  • Skin / itch: Calamine lotion
  • Minor cuts: Antibacterial rinses, sprays, creams and ointments (i.e. Polysporin)
  • Other: Mild Hydrocortisone Cream, Saline eye rinse, mildly medicated eye drops
Please list any over-the-counter meds to which
you oppose being given to this individual.
Prescriptions currently being taken.
Please provide need-to-know information.


Any medications you bring 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.


Check areas that apply.. If none, select last box.*Allergies?
Significant injuries / illnesses?
Limitation that may affect camp?
Please provide details for above selection

Need to Know:

Fill out if you are the guardian!  If not, please contact the guardian and have them fill out the form listed here.   This short form asks for the Need-toKnow information, the waivers and the signature. Parents should sign below as well.    

The following information is crucial for our Wellness Director to prepare a supportive and caring plan for your child to have a successful week at camp. He/she may give you a call to seek relevant information. Your understanding as a parent is crucial to help us support your child.

Check areas that apply.. If none, select last box.*Social / Academic difficulties at school
Tendency for aggressive behaviour
Tendency to be bullied
Sleep Activity
Significant changes in family relationships
Behavioral concerns (ie. ADHD, Depression)
Special habits, emotional, or physical needs
Issues such as eating disorders or cutting
Received counseling or psychological help
None of the above
Please provide details for above
(we may also call for more information)


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 4 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 give Sagitawa permission to give my child's mailing or email address to the cabin leader.

Note: We teach cabin leaders to contact parents for permission first.
Optional Waiver 3:
I grant permission for Sagitawa to use pictures of my child in the cabin picture, camper journal and DVD.
Optional Waiver 4:
I further permit Sagitawa to use pictures of my child 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 is intent to sign)


Please have student registering for PCLT answer the following question.  (Can also do it by email through "Contact Us".)

PCLT Registrants: Please share your reason(s)
for wanting to attend.
I plan to challenge PAL ($25) with CORE (I am 18+)

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

Total Fee
"Unbound" $100
PCLT $50
CORE $210
Pushing the Limit $100


Camp Fee (total from above chart)**
Tuck (optional - $10-20)

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)
Please call me for Credit Card info
Best number and time to reach me
I will send a cheque or money order (see below)
How shall we send receipt?*
Details for other method or for recipient other
than parent name as listed above.
I'd like to apply for sponsorship. I will contact
the camp office for information.