Guardian Authorization for Camper 

This form provides a way for the guardian to provide sensitive information along with a signature when the camper is registered by a care-giver that is not the guardian. If you prefer to use a the phone for the need-to-know information, then please leave that part blank and fill in the name, camp, and signature portion here.

       Fields with * are required


First Name*
Last Name*
Date of Birth (mm/dd/yy)*

Need to Know:

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 selection
(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)*

Camp Sagitawa
Box 61, Moberly Lake, BC V0C 1X0