First Name	Initial	Last Name	Gender
			Male Female
Address	Town/City		Province	Postal Code
			AB BC MB NB NL NS NT NU ON PE QC SK YK --
Birthday (MM//DD/YYYY)	Age by December 31 of camp year		Grade
/ /
Personal MB Health # (9 digit)		Family MB Health # (6 digit)
Cabin Mate Request (Both campers must request each other and be of the same age and same gender- max 2 names.)
Bring A Friend - Sign up a friend to come to camp on the same week as you and receive a $15 store credit as a Thank You! (Friend cannot have been to Camp Arnes before and cannot be a sibling, and two first time campers cannot sign up each other.)
Name of Friend

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Parent / Guardian Information
Parent / Guardian Name:
Father/Guardian's First Name:
Father/Guardian's Last Name:
Mother/Guardian's First Name:
Mother/Guardian's Last Name:
Father/Guardian's Primary Phone: (including area code)	(eg. 204-555-5555)
Father/Guardian's Secondary Phone: (including area code)
Father/Guardian's Work Phone: (including area code)
Mother/Guardian's Primary Phone (if differs): (including area code)
Mother/Guardian's Secondary Phone: (including area code)
Mother /Guardian's Work Phone: (including area code)
E-Mail:
(Mom & Dad receive an update via email of your child's week while they are at camp)
If parents are divorced or legally separated, who has custody?  Mother  Father
If parent(s) /guardian cannot be reached in an emergency, please contact: Relationship of emergency contact person to camper: Home Phone Work Phone Cell Phone
Church Denominational / Religious Background (optional)

List any Allergies your child has including food and/or medication.	Reaction to the allergen and how it is handled
Please list any MEDICATION your child is on, as well as the DOSAGE AND TIMES it is administered. Medications MUST be in ORIGINAL PRESCRIPTION BOTTLES or PACKAGING. Bubble packs are encouraged and are free, ask your pharmacist.
***Any of the following needs that may require special attention at camp? PHYSICAL  EMOTIONAL  BEHAVIOURAL If any of the above is checked, please specify:
Does your child have any of the following. (check all that apply):
Asthma Seizure Disorder	Migraines  Bed Wetting
Please give any other helpful information for your child:
You may receive additional paperwork which MUST be completed and returned to camp before application is considered complete. Camp Arnes receives standing orders from a licensed physician.  Should your child have a headache or become ill it may be necessary to give them medications that are administered by the camp nurse. Please list any medication you DO NOT want your child getting from the nurse while at camp:
Medical Policy: All prescribed medication must be sent in the ORIGINAL BOTTLE (pleas send sufficient supply with a few extra).  All medications will be administered by the camp nurse.  If the medication is not in the original bottle or the label is not legible IT WILL NOT BE ADMINISTERED.  Any over-the-counter medication must be in the ORIGINAL PACKAGE and be accompanied by parent instructions.

Clean and Green By raising money for Camp Arnes you can reduce your fees for the summer. More information is available here. Sign me up for Clean and Green to help lower my cost of camp. I agree to take full responsibility for my receipt book, all money I collect and I promise to return the receipt book(s) and money in full otherwise I agree to pay a fee of $100 to Camp Arnes.

Method of Payment	VISA MasterCard
Card #	(no space between #s)
Expiry Date	MM 01 02 03 04 05 06 07 08 09 10 11 12 / YY 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Name on Card