Camper Application Form

AUGUST 20-26, 2023

Camp is on beautiful Lake Pringle in Cloyne, Ontario.

$700 (to be confirmed) per camper due June 1st follow registration for details.
Fees are reimbursable until July 1st and in accordance
with public health guidelines.

GTA transportation included from Holy Trinity Armenian Church departing Aug. 20 at 8 am, returning Aug. 26 around 4 pm. Ottawa and Montreal pickup locations and schedules are still to be determined.

Please do not hesitate to email us at info@campararat.ca
or call Ani Altounian at (416) 473-3921 with any questions.

CHILD'S FIRST NAME

CHILD'S LAST NAME

ԱՆՈՒՆԸ ԵՒ ՄԱԿԱՆՈՒՆԸ ՀԱՅԵՐԷՆՈՎ - FIRST AND LASTNAME IN ARMENIAN

GENDER *

DATE OF BIRTH *//

AGE AT CAMP *

CHILD'S EMAIL *

Confirm Email

ADDRESS *

APT. # *

CITY *

PROVINCE *

POSTAL CODE *

FATHER'S NAME *

First

Last

MOTHER'S NAME *

First

Last

FATHER'S EMAIL *

Confirm Email

MOTHER'S EMAIL *

Confirm Email

HOME PHONE *

FATHER'S CELL PHONE

FATHER'S BUSINESS PHONE

MOTHER'S CELL PHONE

MOTHER'S BUSINESS PHONE

WHICH PARENT CAN WE REACH DURING THE TIME YOUR CHILD IS AT CAMP? *

EMERGENCY CONTACT INFORMATION (OTHER THAN PARENT/GUARDIAN) *

EMERGENCY CONTACT INFORMATION RELATIONSHIP *

EMERGENCY CONTACT INFORMATION PHONE *

CONFIDENTIAL MEDICAL INFORMATION *

FAMILY PHYSICIAN

PHYSICIAN'S PHONE

LIST ALL ALLERGIES OR SENSITIVITIES TO ANY DRUGS, FOODS, OR ENVIRONMENT *

* An additional medical form will be mailed with the welcome package and all medication will be administered to the child as directed in writing.

NAME TWO FRIENDS OR ACQUAINTANCES, OF SIMILAR AGE AND GENDER, YOU’D LIKE TO BE BUNKED WITH AND ALL OTHER CONSIDERATIONS/REQUESTS

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Last

SELECT YOUR CAMP ARARAT T-SHIRT SIZE *

IS THIS THE CAMPER’S FIRST OVERNIGHT CAMP EXPERIENCE? *

Please check to confirm that you have made your fee payment of $650 via e-transfer payment to PAYMENT@CAMPARARAT.CA and include the camper's name in subject line. *Fees are reimbursable until July 1st, 2022 or in accordance with public health measures.

I CONFIRM THAT I HAVE MADE THE PAYMENT FOR THIS CAMPER

PLEASE ADD YOUR E-TRANSFER PAYMENT CONFIRMATION NUMBER

NAME AND ADDRESS OF TAX RECEIPT RECIPIENT

BY SUBMITTING THIS APPLICATION I/WE CONFIRM THAT AS PARENT/GUARDIAN OF THE CHILD HAVE SOUGHT COMPETENT ADVICE WITH RESPECT TO MY/OUR CHILD’S HEALTH AND WELL BEING PRIOR TO COMPLETING THIS FORM. I/WE AGREE TO RELEASE THE ARMENIAN HOLY APOSTOLIC CHURCH CANADIAN DIOCESE, CAMP ARARAT AND ITS MEDICAL STAFF, COUNSELLORS AND SUPERVISORS OF ANY LIABILITY. IN THE CASE OF AN EMERGENCY, MEDICAL/HOSPITAL SERVICES MAY BE REQUIRED FOR THE CAMPER/PARTICIPANT. I/WE UNDERSTAND THAT EVERY REASONABLE EFFORT WILL BE MADE BY THE CAMP/HOSPITAL SERVICES TO CONTACT ME/US. THIS IS MY/OUR AUTHORIZATION TO HAVE MEDICAL PERSONNEL AND/OR HOSPITAL STAFFS ADMINISTER MEDICAL OR SURGICAL SERVICES, INCLUDING ANAESTHESIA AND DRUGS TO THE CHILD. I/WE UNDERSTAND THAT ANY COSTS RELATING TO SUCH MEDICAL SERVICES BEING REQUIRED WILL BE MY/OUR RESPONSIBILITY. *

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Middle

Last

By submitting this application, we confirm that as parent/guardian of the child and the child have read the Code of Conduct, the Freedom of Information and Protection of Privacy Act, and the Waiver and Release of Liability Agreement (www.campararat.ca/code-of-conduct-privacy-waiver/) and agree to their terms and conditions, and to extend our full cooperation to the Camp counsellors and staff during the child's stay at Camp Ararat. *

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SAVE AND RESUME LATER