Northland Bible Camp

For Family Camp registrations, please email [email protected]
For Hockey Camp please register via HMI’s site, hockeyministries.org

Personal Information (all personal info fields are mandatory)

Camper's First Name:

Camper's Last Name:

Date of Birth (YYYY-MM-DD):

Gender:

FemaleMale

Grade:

Age:

Address:

City:

Province:

Postal Code:

Parent/Guardian's First Name:

Parent/Guardian's Last Name:

Email:

Mobile Phone:

Home/Alt Phone:

Emergency Contact (if parents are unavailable) Please include name, relationship phone number, etc.:

Requested Cabinmate:

Been to Northland Before:

YesNo

Health Information

Health Card No.:

Family Doctor:

Doctor Address:

Doctor City:

Doctor Phone Number:

Subject to Bed Wetting:

YesNo

Recent diseases/operations:

Handicaps/limitations:

Allergies:

Special Medications:

Other Useful Info:

Camp Session:

Price:

HST:

Total:

Authorization:

By submitting and paying you agree that: This health history is to my knowledge correct and the camper described has permission to engage in all prescribed camp activities, except as noted by me. In the event I cannot be reached in an Emergency, I hereby give permission to the Physician selected by the Camp Manager to secure the proper treatment for, to hospitalize, order injection, anesthesia or surgery for my child as named on this application. All expenses not covered by Health Insurance will be my own.

For payment please send your email money transfer to [email protected] Please use the password Otter and indicate in the message part of the transfer the name(s) of the camper(s).

We will tell the next generation the praiseworthy deeds of the Lord, his power, and the wonders he has done. - Psalm 78:4

Registration

Personal Information (all personal info fields are mandatory)

Health Information

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