Camp Dates: Start *
Camp Dates: End *
Mother’s Name: *
Mother’s Email Address: *
Mother’s Telephone: Eg 000-000-0000 *
Mother’s Health Card #: *
Mother’s Address: *
Mother’s T-Shirt Size: * Please Select... Small Medium Large X-Large XX-Large
Family Special Needs:
Family Medical Needs:
Family Dietary Needs:
Social Workers’ Name: *
Social Workers’ Email Address:
Social Workers’ Telephone: Eg 000-000-0000 *
Social Workers’ Agency or Organization: *
Is there a birthday in this family this week? If so, who is celebrating and when?
Child’s Name: *
Age: *
Child’s Health Card #: *
Gender: * Please Select... Male Female Other
Child’s T-Shirt Size: * Please Select... Small Medium Large
Child’s Name:
Age:
Child’s Health Card #:
Gender: Please Select... Male Female Other
Child’s T-Shirt Size: Please Select... Small Medium Large
Child’s Name:
Age:
Child’s Health Card #:
Gender: Please Select... Male Female Other
Child’s T-Shirt Size: Please Select... Small Medium Large
Child’s Name:
Age:
Child’s Health Card #:
Gender: Please Select... Male Female Other
Child’s T-Shirt Size: Please Select... Small Medium Large
Family Agreement
Please read the family agreement and submit below.
The mother acknowledges that she has read and understood the below code of conduct and agrees on behalf of herself and her children to comply.
The Directors reserve the right to send home, at the mother’s expense, any family who has breached this code.
Reasonable precautions are taken for the safety of our campers, but in the event of injury or sickness, the mother releases Camp Cucumber, and its Directors, from any liability.
The mother will be responsible for the expense of any medical attention given to the mother or her child(ren) for which a third-party charges fees.
The undersigned hereby gives Camp Cucumber permission to use your family’s photographic likeness in all forms and media for marketing purposes.
Camp Cucumber will not be responsible for lost or stolen property.
Camp Cucumber is committed to making the camp environment safe and fun for everyone. Accordingly, all families agree to this “code of conduct”.
Code of Conduct:
Commit to being on time for all programs and participating fully
Fully cooperate and follow directions to ensure safety for all
Treat all members of the camping and staff family with courtesy and respect
Refrain from using rude and offensive language
Avoid all unwanted physical contact with other campers and staff
Refrain from bringing fireworks, illegal drugs, alcohol, or intoxicants
Remain on the camp property at all times unless accompanied by a staff member
Please note it is not possible to anticipate every situation. Common sense and courtesy shall prevail.
Consequence: If a family is unable to find harmony within our community and displays any of the above undesirable behaviour the family will be dismissed. Transportation back to the city will be at the families expense. The camp fee will not be refunded.
Declaration: By submitting this form, we understand and agree with the above “code of conduct”, including the consequences for violating it. Any questions we have relating to this code have been answered to our satisfaction.
Upon acceptance of this application I agree to pay the $50.00 non-refundable fee. Please e-transer the funds to diane@campcucumber.com. *
