WDDS » Youth Camp Registration

Mark Break Youth Camp fee is $250 and can be paid at our main office at: 212 Bysham Park Drive Woodstock, Ontario N4T 1R2 or by phone at 519-539-7447
- I will call to register
- I will come to the main office to register
Availability for campers requiring specialized supports may be limited/ require additional costs (to be determined by camp coordinator).
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

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

Please list 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
Dose
Time of Administration
Reason
Name of Med #2
Dose
Time of Administration
Reason
Name of Med #3
Dose
Time of Administration
Reason
Name of Med #4
Dose
Time of Administration
Reason

The following questions help provide our camp staff information to plan for activities and match required support for your camper's needs. If no concerns or input please state in the box "no concerns".
Ho do we support your Camper about street safety?
What level of understanding does your camper understand personal space (toughing/hugging)?
Please list the type of activities your Camper enjoys or any ideas your Camper may enjoy or like to try,
Please describe how to best support your Camper with communicating with others. Do you have any suggestions that will help us to communicate with your Camper better? Does your Camper have communication device/picture board with them?
Is there any other information that you think we should know to help support your Camper to have a great experience at camp?
Does your Camper have any friends also attending our camp? Who? This helps with planning trips.

Youth Camp Registration