CAMPER APPLICATION FORM "*" indicates required fields Step 1 of 7 14% CompanyThis field is for validation purposes and should be left unchanged.CAMPER INFORMATIONUpload Picture of Applicant* Drop files here or Select files Max. file size: 128 MB. Last Name* Last First Name* First Middle Initial Middle Address Street Address City State / Province / Region ZIP / Postal Code Age*Date of Birth (dd/mm/yyyy)* Sex*Current Grade*Camper Role*Patient ON treatment for cancerPatient OFF treatment for cancer sinceSibling of a child ON/OFF treatment for cancerBereaved siblingChild of parent with cancerIn order to give you the very best time at camp, we would like to know a little bit about you and your interests:Do you have any hobbies? What are they?What are your favorite games?What are your favorite sports?What are your favorite crafts?Have you been to camp before? Where and when?Was camp fun? Why or why not?What would you most like to do at camp?Is there anything you would like to tell us that we did not ask?Please rate your swimming ability*Not at allAverageVery wellWhat is your T-Shirt size?*Child SmallChild MediumChild LargeAdult SmallAdult MediumAdult LargeAdult XLAdult XXLAdult 3XLYou will come to camp on a bus. Which bus will you be taking?*SaskatoonReginaCCOF policy is to provide a hotel room for campers travelling 2+ hours to a departure city. Does this apply to you?* Yes No DEADLINE FOR APPLICATIONS IS FRIDAY MAY 14, 2027 Camp Circle O’ Friends is committed to ensuring that every eligible camper has the opportunity to attend camp. If you are able to contribute the camp fee ($40.00), you may choose to submit payment via E-transfer. If you require sponsorship for your child to attend camp, please select the appropriate option below.Would you like to pay the camp fee?* I would like to pay the camp fee My child requires sponsorship The camp registration fee is $40.00 per camper. Payment can be submitted via e-transfer to the following email address: cfriends@sasktel.net When sending your payment, please include your camper’s full name along with “Registration 2027” in the memo line so we can accurately process your payment. REGISTRATION CONSENT FORMI,Untitledwish to registerUntitledfor Camp Circle O' Friends Inc. on June 10-13, 2027.Consent to ParticipateI give my child permission to participate fully in all activities of the Camp Circle O Friends Inc. program (unless otherwise specified on the MEDICAL HISTORY FORM). I agree that any change(s) will be communicated in writing to the Camp Director.* Yes No Consent FOR TRANSPORTATIONI agree to allow Camp Circle O Friends Inc. staff to transport my child to and from camp and during any camp activities on sites for the duration of camp.* Yes No I agree to allow Camp Circle O Friends Inc. staff to transport my child to Regina General Hospital in Regina, SK or Jim Pattison Childrens Hospital in Saskatoon, SK in case of a medical emergency.* Yes No Consent TO MEDICAL CAREI give Camp Circle O Friends Inc. permission to provide medical care for my child if required.* Yes No Consent for releaseI hereby agree to indemnify all and save harmless organizers and volunteers with respect to any claim, which could be made on account of the above named person's attendance at camp.Date (dd/mm/yyyy)* Signature of Parent/Guardian* PARENT/GUARDIAN INFORMATIONLast Name* Last First Name* First Address Street Address City State / Province / Region ZIP / Postal Code RELEASE FORM Authorization to Reproduce Physical LikenessI,UntitledofUntitledin the province of Saskatchewan hereby give Camp Circle O' Friends Inc. all rights to of every kind and character whatsoever in and to all work heretofore done and all poses, acts, plays, and appearances heretofore made by me for it as well as in and to the right to use photographs, either still or moving, for promotional purposes. Photographs may be used on promotional material including and not limited to print materials, multi-media presentation, the Camp Circle O' Friends Inc. website and/or affiliates including sponsors, and social media accounts, or the Children's Oncology Camping Association website.Date (dd/mm/yyyy)* Signature of Guardian*Name of Guardian* CAMPER MEDICAL HISTORY FORM - 2027Last Name* Last First Name* First Middle Initial Middle Age*Date of Birth (dd/mm/yyyy)* Sex*Current Weight*Current Height*Sask. Health Insurance Number*ALLERGYDoes the camper have any allergies?* Yes, he/she does No, he/she does not EnvironmentalSeverityMildSevereTreatment GivenAnimalsSeverityMildSevereTreatment GivenInsectsSeverityMildSevereTreatment GivenFoodsSeverityMildSevereTreatment GivenMedicationsSeverityMildSevereTreatment GivenMedicationsSeverityMildSevereTreatment GivenDoes the camper carry his/her own epi-pen? (please send pen if required)* Yes No MEDICATIONS Please list any medications your child will need to receive at camp.DO NOT PLACE MEDICATIONS IN DOSETTES Please send all medications (both prescription and over-the-counter) in their original containers.MedicationsDoseTimesSpecial RequirementsMedicationsDoseTimesSpecial RequirementsMedicationsDoseTimesSpecial RequirementsMedicationsDoseTimesSpecial RequirementsMedicationsDoseTimesSpecial RequirementsMedicationsDoseTimesSpecial RequirementsMedicationsDoseTimesSpecial RequirementsMedicationsDoseTimesSpecial RequirementsPlease indicate if camper experiences or has experienced any of the following problems:Headaches*YesNoUnknownPlease give detailsConvulsions/Seizures*YesNoUnknownPlease give detailsFainting Spells*YesNoUnknownPlease give detailsVision Problems*YesNoUnknownPlease give detailsHearing Problems*YesNoUnknownPlease give detailsBreathing Problems*YesNoUnknownPlease give detailsHeart Problems*YesNoUnknownPlease give detailsBlood Clotting Problems*YesNoUnknownPlease give detailsStomach/Bowel Problems*YesNoUnknownPlease give detailsSkin Problems*YesNoUnknownPlease give detailsFrequent Infections*YesNoUnknownPlease give detailsDiabetes*YesNoUnknownPlease give detailsEmotional Problems*YesNoUnknownPlease give detailsHyperactivity*YesNoUnknownPlease give detailsHyperactivity*YesNoUnknownPlease give detailsSleepwalking*YesNoUnknownPlease give detailsBedwetting*YesNoUnknownPlease give detailsWalking Problems*YesNoUnknownPlease give detailsOtherPlease indicate if camper has had the following illnesses:Chicken Pox*YesNoUnknownDate (dd/mm/yyyy) Shingles*YesNoUnknownDate (dd/mm/yyyy) Measles*YesNoUnknownDate (dd/mm/yyyy) Mumps*YesNoUnknownDate (dd/mm/yyyy) Rubella (German Measles)*YesNoUnknownDate (dd/mm/yyyy) Please indicate if camper has had the following immunizations:MMR*YesNoUnknownDate (dd/mm/yyyy) Meningitis*YesNoUnknownDate (dd/mm/yyyy) Tetanus*YesNoUnknownDate (dd/mm/yyyy) Chicken Pox (Varivax)*YesNoUnknownDate (dd/mm/yyyy) Hepatitis B*YesNoUnknownDate (dd/mm/yyyy) Covid Vaccine*YesNoUnknownNumber of DosesDates ReceivedHas the camper had any major illnesses or operations?* Yes No Please explain (include things like VP shunts, rods, pins, prosthesis, etc.)*Has the camper menstruated?* Yes No Not Applicable Is their menstrual cycle normal?* Yes No Have they been told about it?* Yes No Does the camper have any particular fears? (i.e. the dark, water, heights, animals, medical procedures, etc.)*Does the camper have any dietary restrictions?*Does the camper have any disabilities or special challenges? (i.e. physical, emotional, learning, developmental or behavioral)* PARENT/GUARDIAN CONTACT INFORMATIONName of Contact 1* First Relationship to Camper*Cell Phone Number*Other Phone Number*Name of Contact 2* First Relationship to Camper*Cell Phone Number*Other Phone Number*MEDICAL CONTACT INFORMATIONDoes the camper have a family physician?* Yes No Name of Family Physician, Clinic, Phone # (include area code)*Does the camper have a family dentist/orthodontist?* Yes No Name of Dentist/Orthodontist, Office, Phone # (include area code)* FOR ONCOLOGY PATIENTS ONLY (PAST AND PRESENT)If your child has been an oncology patient at ANYTIME, this page MUST be completed.Has the camper been an oncology patient at ANYTIME?* Yes No Diagnosis*Date of Diagnosis (dd/mm/yyyy)* Has the camper had any relapses?* Yes No If yes, when? (dd/mm/yyyy)* In the past, has the camper received (select all that apply):* Chemotherapy Radiation Is the camper receiving treatment now?* Yes No When was the last treatment? (dd/mm/yyyy)* When was the treatment completed? (dd/mm/yyyy)* What chemotherapeutic agents were given?When is the next treatment scheduled? (dd/mm/yyyy) Does your child have a central line or a portacath?* Yes No Name of Oncologist, Full Address, Phone # (include area code)*
