Online Mint Brook Summer Camp Application
Be sure you have downloaded all the information!
Indicate which Camp Session you wish to attend)
GIRLS {8-13/14} ---BOYS {8-13/14}
Family Name and First Name
Parent or Guardian Name
Mailing Address
Home Telephone
Email
Business Phone and
Address
Have you been to
camp before ? Yes/No
Can you swim?
Yes/No
Do you have canoeing
experience ? Yes/No
Whom Do You Want
For A Cabin Mate?
My AGREEMENT
Please Type your Name
I understand that by typing my name
it is the same as my signature:

Camper:
I agree to participate in all camp activities
Camper’s signature

I APPROVE THIS APPLICATION
PARENT/S SIGNATURE


Your Parish Priest's Name here
You must notify your priest when applying
for camp!
PERSONAL HEALTH RECORD

Name

MCP #

In case of emergency contact:
Please Type Name, Address   And
Telephone

Family  Doctor
Please Type Name, Address   And
Telephone
Camp events will include swimming, sports, crafts, canoeing, hiking, running etc.
If your child has any physical or emotional disorder that would prevent him/her
from participating in the program, please use the block below to explain details.
Please Type Yes or No  if
your child is subject to
any of the following:

Asthma

Bedwetting


Ear Trouble


Fainting

Heart Trouble


Migraines


Nosebleeds


Sleepwalking


Tonsillitis


Sore Throat

Skin Disease

Other (Please Name)
Does your Child have allergies? Please indicate Yes or No
If they do,please describe the allergy below

Please list any medications the camper may be bringing and the reason for it
Medications must be labelled and handed in upon arrival.
Is there any other information the staff should be aware of?

Please read carefully before signing
I understand that by typing my name it is the same as my signature:
In case of a medical emergency, I understand that every reasonable effort will
be made to contact me. In the event that I cannot be reached, I give permission
to the doctor, selected by the Camp Director , to give proper treatment to my
child.
Your Name,and Date
Any Questions?