Parent/camper Details Registration (R) 1st PARENT/GUARDIAN INFORMATION 1st Parent/Guardian Name * 1st Parent Guardian Last Name * Address Line 1 * Address Line 2 City * Province * Postal Code * Country * Email Address * Enter Email Phone * Phone (Alternate) Workplace Would you like to receive email updates and newsletters about the exciting things going on at Ross Creek & Two Planks? Yes, I love staying in the loop! Add an Additional Parent/Guardian 2nd PARENT/GUARDIAN INFORMATION 2nd Parent/Guardian Name 2nd Parent Guardian Last Name 2nd Parent/Guardian Name 2nd Parent/Guardian Name First First Last Last If 1st Parent/Guardian Address is the same, it is not required to be entered 2nd Parent/Guardian Address Line 1 Address Line 2 City Province Postal Code Country 2nd Parent/Guardian Address 2nd Parent/Guardian Address 2nd Parent/Guardian Address 2nd Parent/Guardian Address City City Province/State Province/State Postcode/Zip Postcode/Zip Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country 2nd Parent/Guardian Email Address Enter Email Confirm 2nd Parent/Guardian Email Address Confirm Email 2nd Parent/Guardian Phone 2nd Parent/Guardian Workplace Lives with 1st Parent/Guardian YES NO Support Worker Yes No Is this registration is being filled in by a support worker? If yes please give the name, email, and phone of the support worker. Anything we should know about your family? URGENT CONTACT INFORMATION Urgent Contact Name * Urgent Contact Name First First Last Last Urgent Phone * Relation to 1st Parent/Guardian * Alternate pickup Authorization? CAMPER/CHILD INFORMATION To add additional children, please register and then repeat this form. Camper Information Child/Camper Full Name * First Name Last Name Preferred Name (What does your camper like to be called?) * Birthdate * Gender * SELECT Male Female Gender Fluid Non-Binary Other Gender Pronouns She/Her He/Him They/Them She/Them He/Them All Pronouns OtherOther School Name / Homeschooled Grade (or equivalent) Main Teacher or Art Teacher’s name HEALTH INFORMATION Doctor’s Name MSI/Healthcard Number Are your child’s immunizations up to date? * YES NO If No, please detail: * Does your child have any immunodeficiency issues? * YES NO If Yes, please detail: * Health * Medications * Dietary preferences * None None, but a picky eater Vegetarian Vegan Pescatarian No Red Meat Gluten Free Celiac Kosher Halal Nut-free Dairy-Free Lactose Intolerant Wheat Free Egg allergy Dietary/ FOOD Allergy Information * Camper Notes 1st Parent/Guardian Name * 1st Parent/Guardian Name 1st Parent/Guardian Name Last Last If you are human, leave this field blank. Register
