Kids Rocket Camp Online Registration

August 13-17, 9:00 a.m. - 12:00 a.m.
**Total Cost of Camp is $20.00/child**
For more information contact: kidscamp@gracechapel.ca

Names of Parent(s): *

Home Address *

Home City *

Home Postal Code *

Email Address *

Mobile Number *

Phone Number

Work Phone Number(s)

How did you hear about this camp?

Emergency Contacts: *

Please provide the names and mobile numbers of 2 people if we are not able to get in touch with you in case of an emergency.

Name of Child *

Date of Birth *

Gender *

Heath Card Number *

Does your child have any physical, emotional, mental, behavioural concerns or limitations that staff should be aware of? *

If "Yes" please explain.

Does your child have any allergies? *

If "Yes" to allergies please explain.

Is your child bringing any medications with him/her? *

If "Yes" to medications, please list here. Please also list any medication that your child is currently taking.

I will download, print, sign, scan, and return the "Legal Permission" form that may be found at this link: