Leadership Development Program (2009-2011) (Girls)

Important: After you have completed the LDP Registration Form here, please download the LDP Application Form from the Downloads tab under summer camp. This application form compliments the registration form and is an important part of the program. It is meant to be completed by the LDP camper. Completed applications can be emailed to: info@valleyviewbiblecamp.com or mailed to: PO Box 430 MacGregor MB R0H 0R0.

Child's First Name *

Child's Last Name *

Sex *

Female

Age on First Day of Camp *

Birthday *

Please use the format yyyy-mm-dd
I.e. 2000-03-31

Previous Camper *

Yes

No

Where did you hear about us?

Guardian/Parent Name *

Guardian Relationship to Child *

Example: mother, father, legal guardian, grandparent, etc.

Phone *

** Please enter phone with no spaces or symbols. **
Correct Example: 204123123
Incorrect Example: 204.123.123 or 204-123-123 or 204 123 123

Email *

** Please check that email address is entered correctly. If you do not receive a confirmation email shortly after submitting this form, send an email to info@valleyviewbiblecamp.com. **

Mailing Address *

City *

Province *

Postal Code *

**Please enter in CAPS with one space and no symbols.**
Correct Example: A1B 2C3
Incorrect Example: A1B2C3 or A1B-2C3

Is your physical address different from your mailing address? *

Yes

No

Physical Address

Emergency Contact Name *

Emergency Contact Phone Number *

** Please enter phone with no spaces or symbols. **
Correct Example: 204123123
Incorrect Example: 204.123.123 or 204-123-123 or 204 123 123

Emergency Contact Relationship to Child *

Family Health # (6 digit) *

Personal Health # (9 digit) *

Any Medical/Behavioral Concerns *

Yes

No

Type of Medical/Behavioral Concerns

Does your child take medication? *

Yes

No

Sometimes

If yes, please list the medication(s): *

Allergies *

Yes

No

If so, which allergies? *

Do they have any prescribed allergy medication(s)? Please list. *

Does your child have any dietary restrictions/needs? *

Yes

No

If so, please describe *

Would this camper benefit from a one-on-one team member? *

Yes

No

If so, why? *

Optional Cabin Mate Request (one only)

T-Shirt Size *

How often do you attend Church? *

How often do you attend any Christian Club? *

How often do you attend youth group? *

Did you receive a camp postcard? If so, where? *

Comment

1. Participation in activities could result in possible personal injury. Despite precautions taken by the ministry point, accidents and injuries may occur. By signing this form, I assume all risks related to the use of any and all spaces used by the ministry point.

2. To release from responsibility, the ministry point, including all missionaries, full-time and part-time, paid or volunteer, and the facilities used from any cause of action, claims, or demands now, and in the future that might arise out of the participant’s participation in activities at the ministry point or from the physical risks associated with the activities.

3. I accept all risks relating to such activities including personal injury such as: cuts, sprains, scrapes, bruises, fractures, broken bones, concussions, death, or any personal property damage/loss, which may occur on the camp premises. I understand these risks and will not hold the ministry point liable for any such injury.

4. Furthermore, I agree to obey all ministry point rules and take full responsibility for my behaviour in addition to any damage I may cause to the facilities utilized by the ministry point.

IN CONSIDERATION of being permitted to participate in any way at Valley View Bible Camp, (hereafter known as ministry point) operated by One Hope Ministries of Canada , I acknowledge, understand, and agree:

Camp Agreement *

I have read this Informed Consent and Assumption of Risk Agreement, fully understand its terms and the risks I am assuming by signing it, and sign it freely and voluntarily.

In case of emergency *

In case of emergency, I understand every effort will be made to contact me. In the event that I cannot be reached in an emergency situation, I hereby give permission to licensed emergency and health care personnel to provide treatment, services and transport necessary to maintain the health of my child. In the event medication, medical advice, treatment and/or equipment are required, I agree to accept financial responsibility for fees in excess of provincial and or private medical insurance. I agree that the information on this form may be disclosed to such emergency and health care personnel. In the event of illness, accident, emergency, or any other circumstance requiring medical treatment, such treatment may be procured for the participant without legal or financial obligation to Valley View Bible Camp and One Hope Canada. All known health issues of my child have been stated to the camp. I will notify the camp if my child is exposed to any infectious diseases prior to arriving at camp.

Over-the-Counter Medication

I give permission for the camp to administer over-the-counter medicines/medications to my child.

I agree to allow photographs and videos

I agree to allow photographs or video of camp activities, which may include my child, to be used in any and all camp promotional material including the sharing of photographs and videos with ministry partners of One Hope Canada.

Agree to share

I agree to allow Valley View Bible Camp to share my name, address & phone number with personnel & churches affiliated with the camp.

Right to request *

Valley View Bible Camp reserves the right to request any participant to withdraw from their camp if the participant is not acting in an appropriate and responsible manner.

Permission to connect

You give permission to our missionaries to stay in contact with your son or daughter. If you wish to discuss this further, please contact the camp director by phone or email. If you wish to withdraw your permission, please contact the camp immediately to notify the camp director. For more information, please visit insafehands.ca.

Understood the terms of this agreement *

I have read and understood the terms of this agreement and BY ALLOWING MY CHILD(REN) to participate in the camp, I am voluntarily agreeing to abide to these terms. I confirm that the participant [my child] is physically and mentally able to participate in all activities of the camp, unless specifically indicated otherwise in writing.

TWELVE App

I agree to allow my child to download and use the One Hope Canada TWELVE app (formerly known as Faith Spark), so that he/she can participate in live events, camp and cabin chats.

Cancellation Policy *

With the exception of a medical emergency, cancellations can be made no later than two weeks prior to camp session, and will be subject to a $50 administration fee deducted from refund.

Amount

$

Payment Method *

Mail in cheque, etc. E-Transfer Square Card Payment

Credit Card Number*

Expiration Date*

/

Card (CVV) Code*

Card Holder Name*

Credit or debit card*

If using E-Transfer: send to info@valleyviewbiblecamp.com. Please indicate camper's name in the notes/comments section of the e-transfer.

Individual Registration

VALLEY VIEW BIBLE CAMP & ONE HOPE CANADA MINISTRIES

Informed Consent and Assumption of Risk Agreement

PARENT/GUARDIAN PERMISSION FORM

Payment Information