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info@wdds.ca

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Youth Camp Registration

Step 1 of 6

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WDDS Summer Youth Camp- Registration
- Summer
Camper Information
Is this your first time registering your camper with WDDS?
- Yes
- No
Name*
First Last
Gender*
- Male
- Female
Birthday*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Doctors Name*
Doctor's Phone
Health Card Number (no spaces)*
Health Card Version Number
Camper's Swim Level*
- Non-Swimmer
- Beginner
- Average
- Above Average
Life Jacket Required
- Yes
- No

Parent 1 Information
Parent 1 Name*
First Last
- Same Address as Camper
Parent 1 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent 1 Phone Number*
Work Phone
Cell Phone
Email

Parent 2 Information Secondary Contact/Authorized Pick Up
Parent 2 Name*
First Last
- Same Address as Camper
Parent 2 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number*
Work Phone
Cell Phone
Custody of Camper- Please Specify*
- Both
- Mother
- Father
- Other

Alternate Person Authorized to Pick Up Camper
Name*
First Last
Relationship*
Home Phone
Work Phone
Cell Phone

Does your Camper have any medical conditions we should know about?*
- Yes
- No
If yes, please specify:
Does your Camper have seizures?
- Yes
- No
If yes, please specify what a typical seizure and recovery looks like:
Does your Camper have any allergies?*
- Yes
- No
If yes, please specify what a typical reaction may look like.
Does your Camper carry an EPI PEN?*
- Yes
- No
Does your Camper carry a medical alert bracelet?*
- Yes
- No
Does your Camper carry a safety plan at school?*
- Yes
- No
Do you consent for WDDS to contact the school? Expired June 28, 2019?*
- Yes
- No
If yes, please specify the school and contact person and details of the plan.
If yes, please specify the school and contact person and details of the plan.
Does your camper require assistance with eating?*
- Yes
- No
Does your camper have any concerns with food? Ie. dietary concerns or allergies.*
- Yes
- No
If yes, please specify
Does your camper requires assistances to use the washroom?*
- Yes
- No
Does your camper require assistances with dressing?*
- Yes
- No
Does your camper require assistance with walking/assistive devices?*
- Yes
- No
Will your camper be arriving by taxi or para transit?*
- Yes
- No
If yes, please specify cab company and drop off and pick up times

Please lis any medications your Camper requires while at camp. Original containers and clearly labeled.
Please complete for medial emergencies if your Camp is taking any consistent medications.
- No Medications
Name of Med #1

Contact us

519.539.7447
info@wdds.ca
212 Bysham Park Drive
Woodstock ON N4T 1R2

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