Special Friends Retreat Winter 2025 - Ages 18+

Attestation of Camper Self Care *

YES

I attest that this camper is fully capable of self care/mobility without aid. This includes eating, bathing, changing clothes, and washroom hygiene. Inability to be independently mobile and care for one's own personal needs may prevent adult camper from participating in our program. If you have questions regarding self care/mobility issues, please contact us at 506-832-4669 prior to registering. *Note: This attestation of self care does not include the administration of medication. All medication will be administered by camp nurse.

Camper First Name *

Camper Last Name *

Parent/Guardian First Name *

Parent/Guardian Last Name *

Phone Contact *

Emergency phone *

Relationship of Emergency Contact *

Address *

City *

Province *

Postal Code *

Country

Email *

Confirm Email *

Sex *

Female (16 available)

Male (12 available)

Age *

Birthdate *

Please indicate birthdate by MM-DD-YYYY

Medicare Number *

Province of Medicare *

Medicare Card Expiry Date (MM/YYYY) *

Health Concerns

Allergies

Medications coming to camp

If medications come in bottle form (ie, not in a blister pack or dossette), please include medication name, delivery times, and dosage. Please ensure that all medication labels are up to date on blisterpaks, dossettes, and/or bottles.

*If registering for the summer teen motorcycle program, please take note: Motorcycle riding requires great concentration and physical ability. Campers with emotional disorders or that take medications with side effects of dizziness, drowsiness, or fatigue, may not be permitted to participate in this program.

Do you give Hampton Bible Camp permission to give your child over the counter medication? (Select only one) *

No

Yes

Yes - With a Phone Call

Over the counter medications at HBC are limited to Tums, Pepto-Bismol, Antihistamine, Acetaminophen, and Ibuprofen.

Cabin mate request

Please note that cabin requests may not be honored if there is an age gap greater than three years for child and youth campers. While not guaranteed, we will do our best to honor all cabin mate requests.

Camper lives with *

Is there anything else we should know about this camper?

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 Hampton 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.

I agree to allow photographs

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.

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.

Right to request *

Hampton 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.

Right to cancel *

Hampton Bible Camp reserves the right to cancel any week of camp and give a 100% refund.

Agree to share

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

Permission to connect

We count it a privilege that you are sending your son or daughter to spend the week with us at camp this summer. During a week of camp, we look forward to many great friendships being formed! We have an amazing summer missionary team, and they love to stay connected with their campers throughout the year to hear how they are doing and answer any questions they may have about the topics discussed during chapel session and cabin devotionals. As part of our child and youth protection policy (www.insafehands.ca) we are committed to honouring you as a parent/guardian and to asking your permission before any contact occurs between campers and our missionaries (Facebook, Twitter, phone calls, etc.). Our missionaries would be honoured to be able to continue to stay involved in your child or youth’s life after camp. Please initial to indicate whether or not 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 (please see camp website for contact information). If you wish to withdraw your permission, please contact the camp office immediately to notify the camp director.

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

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.

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.

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.

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.

I have read *

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.

I, the participant, *

I, the participant, 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.

This is to certify that *

This is to certify that, I, as parent/guardian with legal responsibility for this participant, have read this Informed Consent and Assumption of Risk Agreement, fully understand its terms, and that I have given up substantial rights by signing it, and sign it freely and voluntarily.

Administration Notes (for office use only)

Amount

$

Payment Method *

Offline Payment (E-transfer, or third party invoicing. Cash is accepted, but not preferred) Credit Card (Paypal)

Credit Card Number*

Expiration Date*

/

Card (CVV) Code*

Card Holder Name*

Hampton Bible Camp

Individual Registration

PARENT/GUARDIAN PERMISSION FORM

Informed Consent and Assumption of Risk

Participant Signature (13 years and older)

FOR PARTICIPANTS OF MINORITY AGE

Payment Information