Camp Registration Form

      Fields with * are required


REGISTER ME FOR:

Notice that we have divided the registration drop down menus into our 4 sites.
Dropdowns only permit one selection per site, but you may add others into the "Other Sessions" box below.

1. Moberly Lake site camp list . . . . . . . . . . . . . . . . . . . . .

Track Choice at Moberly (K1 - K5 only)

2. SWAT trips list . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. Sagitawa Trail Rides list . . . . . . . . . . . . . . . . . . . . . . . .
     For important Trail Ride information, please follow
     Trail Ride Info link after submitting this form.

4. High Prairie Wilderness Camp list . . . . . . . . . . . . . . .
     For important HPWC information, please follow
     HPWC Info link after submitting this form.

If registering for more than one session at any particular site, please indicate the other camps and tracks below. Note that it is okay to register for two or more camps even at differenty sites.

Other Sessions
Please put me in a cabin with (friend 1)
Note: Trail Rides and HPWC uses Teepees
Please put me in a cabin with (friend 2)
Note: Trail Rides and HPWC uses Teepees

GENERAL INFORMATION:

First Name*
Last Name*
Mailing Address*
City*
Postal Code*
Street Address (if different)
Date of Birth (mm/dd/yy)*
Gender*
Grade (entering)*
Camper Email
Parent Email

CONTACT INFORMATION:

Parent Name(s)*
Phone - home*
Phone - work
Phone - cell
Phone - cell 2

Emergency Contact:

Contact Name*
Phone - emerg.*
Phone - emerg. 2
Relationship to camper*

HEALTH INFORMATION:

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

 

Medications:

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.  www.sagitawa.bc.ca/docs/FirstAidPolicy.pdf

  • 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 first box.*None of the following apply.
Allergies?
Dietary?
Significant injuries / illnesses?
Limitation that may affect camp?
Other?
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. www.se.sagitawa.bc.ca/emailforms/36   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 first box.*None of the following apply.
Social / Academic difficulties at school
Tendency for aggressive behaviour
Tendency to be bullied
Bedwetting
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
Other?
Please provide details for above selection
(we may also call for more information)

Trail Rides and HPWC only..

I need riding boots.
Approximate weight (kg)
Hours of riding experience?

GUARDIAN AUTHORIZATION:

We require the guardian's signature and sensitive need-to-know information. If you are not the guardian, please ask him/her to fill out this form: http://www.se.sagitawa.bc.ca/emailforms/36.

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.
[see sagitawa.bc.ca/docs/privacypolicy.pdf]

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 and PAYMENT INFORMATION:

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 Fee (total from above chart)*

Trail Ride and HPWC registrants do not send Tuck or T-shirt fees - They are now included in registration fees!

Tuck & Crafts (optional $10-30 Moberly only)
$17 Camp T-shirt (optional - Moberly only)
T-shirt size (to reserve)
$7 - DVD of week (optional - Moberly only)
$5 - Camp Journal (optional - Moberly only)

Thankyou 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)
Please call me for Credit Card info
Best number and time to reach me
I will send a cheque or money order (see below)