October 23-25 | Eagle Bay, BC [FEMALES]

Username*

Password*

Retype Password*

If you are a new user, your account will be created when you submit the full form.

⚠ Please keep the username and password information for registering subsequent campers or events for your camper.
⚠ Do not use any symbols or spaces in your username. Letters or numbers only and no spaces.
⚠ All boxes with asterisks must be filled out.

Attendee's First Name *

Attendee's Last Name *

Attendee's Date of Birth
YYYY-MM-DD *

Instructions: Please click the calendar icon and select your birthdate from the calendar. This will ensure the date is formatted correctly.

Gender *

Female

Male

Attendee's T-shirt Size *

S

M

L

XL

2XL

3XL

Who is filling out this form?

Parent or caregiver's name *

Parent or caregiver's phone *

Parent or caregiver's email *

Address *

Address 2

Camper's address if different from above

City *

ZIP *

Country *

Province

Emergency Contacts Name, Phone Numbers, and relationship to camper *

Please upload a recent photo of camper *

Personal Health Care Number *

Please list any known diagnoses for camper *

Does the camper have any allergies? *

Yes

None Known

Please select those that apply

Please list the medication allergies *

Please list the seasonal allergies *

Please list the food allergies *

Please list any other allergies *

Does the camper have epilepsy? *

Yes

No

Type of seizure? *

Petit mal

Grand mal

Focal

Other

Are the seizures under control?

Yes

No

Please give the frequency, length, and any medication procedures *

Does the camper have any mobility issues? *

Yes

No

Please select the following that may apply *

Difficulty with stairs

Difficulty on rough terrain

Uses braces

Uses crutches/cane

Uses walker

Uses wheelchair

Wheelchair-enabled campers must be accompanied by an aide. Only Elkcanoe (in Salmon Arm) and Elkgrove (in Aldergrove) are wheelchair accessible.

Independent in this task? *

Yes

No

Needs Reminders? *

Yes

No

Needs help with zippers *

Yes

No

Wears Attends *

Yes

No

When? *

All the time

Only at night

Participation *

Participates with peers

More of a loner

*** Due to a temporary website issue, we need to ask day campers for rest and sleep information. Although this will not be relevant for day campers, we ask that you fill in this information. Thank you for your patience.

Does camper sleep well? *

Yes

No

Unknown

Does camper have any of the following sleeping issues?

Sleepwalk

Talk in sleep

Insomniac

Fear of the dark

Fear of lightning/thunder storms

Can they use an Upper Bunkbed? *

Yes

No

Is the camper able to communicate verbally? *

Yes

No

Somewhat

Are they easy to understand? *

Easy

Somewhat easy

Hard

Please select the following that apply

Mute

Uses sign language

Uses electronic device

Has 10 words or less

Hears well? *

Yes

No

Understands vocabulary?

Understands spoken words

Has large vocabulary

Has limited vocabulary

Please select the following that apply

Hard of hearing

Total hearing loss

Does the camper wear hearing aids? *

Yes

No

Does the camper need help with hearing aids? *

Yes

No

Does the camper have vision issues? *

Yes

No

Check the vision issues *

Wears glasses

Is blind in one eye

Is legally blind

Needs assistance with eating? *

Yes

No

Please select eating aids *

Needs help carring food to table

Needs help preparing food (cutting)

Needs a straw

Specific dietary concerns?

Please note that we do not serve pop or candy at camp!

Is dental care independent? *

Yes

No

Please check supports needed *

Needs supervision

Needs help with toothpaste

Needs total assistance

Does the camper wear dentures? *

Yes

No

Requires assistance with dentures? *

Yes

No

Is hair care independent? *

Yes

No

Please select grooming supports needed *

Needs reminders

Needs help washing

Needs help brushing

Is skin care and deodorant use independent? *

Yes

No

Please check those that apply *

Needs reminders

Needs supervision

Needs full assistance

Is dressing themselves independent? *

Yes

No

Please check assistance needs for dressing and undressing

Supervision

Help with buttons/zippers

Help with socks/shoes

Total assistance

Do you or the camper require financial assistance with payments?

Yes

No

Any other important information about this camper?

More Comments

Church affiliation (if any)

Return camper or first time camper *

Return

First Time

I have read and understand *

Important: A deposit of $50 is required to secure your registration. Full payment will be due 4 weeks prior to camp, or you can choose to pay the full amount now.

Amount

$

Deposit Amount

$

Payment Type

Payment Method *

e-Transfer (amasa@onehopecanada.ca) Mail-In Cheque Offline Payment Cash

Credit Card Number*

Expiration Date*

/

Card (CVV) Code*

Card Holder Name*

Cheques Pay to the order of: Amasa Ministries

Mail-In Cheque Address:
PO Box 588
Harrison Hot Springs, BC
V0M 1K0

If paying by e-Transfer: reference number of the sent transfer

If paying by cheque: cheque number

Subscribe to our newsletter?

Yes

Individual Registration

Existing user? Please login

New User? Please register

Attendee Information

Parent or Caregiver Information

Medical Information

Mobility

Toileting

Socialization

Rest and Sleep

Language and Speech

Hearing

Vision

Eating

Personal Hygiene

Other

Payment Information