Appendix 9
                                                   Ontario Christian Assembly Inc.
                             Registration Form – Overnight Summer Camp 2017
            Overnight        Grades              Dates of Camp                   Check in         Check out                  Dean(s)
              Camp                                                                 Time             Time
          Primary Camp         1-3       Jul 14th to July 16th  (Fri-Sun)         4:00 pm         11:00 am
           Junior Camp         4-6       July 23rd  to July 29th (Sun-Sat)        4:00 pm         11:00 am
          Jr. High Camp        7-8       July 16th to July 23rd  (Sun-Sun)        4:00 pm         11:00 am
                                                nd          th
           Senior Camp        9-12        July 2   to July 9   (Sun-Sun)          4:00 pm         12 noon
                                                     th                                                             Jerry Maschewski and 
            LIT CAMP          10-12            July 9  to July 29th               2:00 pm         12 noon              Program Director
             Worship          13 to            July 30th to Aug 4th
               Camp           22 yrs           (Sunday to Friday)                 4:00 pm         11:00 am
          NOTES: 
 1.       The school grade is the one being entered into Sept. 2017. 
 2.       The family maximum cost for the above summer youth camps is $550.00. To qualify for this special rate, all campers must
          be registered at least 3 weeks before the first family member attends their week of camp.
          The camp program at Ontario Christian Assembly is sponsored by the Christian Churches of Ontario. There is some free 
          time and outdoor time available to the participants, but each participant is expected to participate in all the scheduled 
          activities. 
          Here are some things to bring: Sleeping bag, jacket for cool nights, pillow, change of clothes, modest swimwear, insect 
          repellent, Bible, notebook, camera, etc. Please do not bring lots of cash, since there is nothing to spend it on at the 
          camp. You will be staying in cabins with 10 campers. If you have a musical instrument, bring it if you wish.
          Cell phones, mp3 players, etc. are prohibited. 
          Camp Location and Contact Information
          The camp is located North of Orangeville, along the Bruce trail. Take Highway 10 North from Orangeville until you come 
          to a “T” end, which is Highway 89. Turn East onto 89, away from Shelburne, and go up the first hill. At the top of the hill 
          you will see a sign for “Hurontario Street,” which is a gravel road. Turn right onto the road, then left at the gate into the 
          camp. Follow the camp road down the hill to the camp site.                                           
          For more information, maps, etc., go to http://wwwocainc.ca  
           Business phone: (905) 776-3847 email:   info@ocainc.ca    Phone 
          number only during camp (519) 925-5901
          During the week of summer camp, mail may be sent directly to
          your camper at:
          (Your Child’s Name)
          c/o OCAI R.R. #4
          Box B-1, Shelburne, ON L0N 1S8
          Keep this page for your Reference – DO NOT MAIL THIS PAGE
                                                                                                                                                1
                                                                                                                                      Appendix 9
                                         2017 Ontario Christian Assembly Inc.
                                   You can pay using PayPal by visiting our Website  www.ocainc.ca  and completing the
                                         
                                   registration form online.
          If you wish to pay by Cheque or Money Order please complete pages 2, 3, 4 and 5 of this form and mail to address at
          bottom of page 5.
          If you wish a year-end receipt please complete the following.
          Family Name on Receipt: ________________________________________________________
          First Name on Receipt: __________________________________________________________
          Address: _____________________________________________________________________
          City: _____________________________________     Postal Code: ___________________
          Phone Number:  (______) _______-____________ Email Address: ____________________________
          Are you taking the bus from Church of Christ Christian Chapel in Selkirk?     ______Yes
          20 Erie Street North 
          Selkirk, ON
          Are you taking the bus from Tile-It (Mountain View Christian Church)?   ______Yes
          3727 Upper James
          Mount Hope, ON
          Are you taking the bus from DC3 (Meadowvale Campus)?   ______Yes
          7755 Tenth Line
          Mississauga, ON
          If you are receiving a discount please enter Discount Code ___________________
                 Overnight                                         Check in     Check       Camp          Early            Early
                                 Grades      Dates of Camp                       out                 Registration     Registration       Dean(s)
                    Camp                                             Time        Time        Fees         Date           Discount
                                             July 14th to July 16th
                Primary Camp        1-3           (Fri-Sun)         4:00 pm    11:00 am      $94      June 15, 2017        $10
                                             July 23rd  to July 29th
                 Junior Camp        4-6           (Sun-Sat)         4:00 pm    11:00 am      $210     June 15, 2017        $20
                                             July 16th to July 23rd 
                Jr. High Camp       7-8          (Sun-Sun)          4:00 pm    11:00 am      $230     June 15, 2017        $20
                                                   nd        th
                 Senior Camp       9-12       July 2  to July 9     4:00 pm     12 noon      $230      June 1, 2017        $20
                                                 (Sun-Sun)
                                                                                                        Separate Registration for LIT     Jerry and
                  LIT CAMP         10-12     July 9th to July 29th  2:00 pm     12 noon      $350       Camp – Use LIT Application        Program
                                                                                                            Form (Appendix 6)             Director
                Worship Camp      Ages 13    July 30th to Aug 4th   4:00 pm    11:00 am      $225
                                  -22 yrs
                    Please check appropriate camp. There is a Family Maximum of $550.00 when paid before first camp attended.
                                                                                                                                                   2
        2017 OCA CAMP FORM – Please complete this section and Mail
                             Registration Form – Overnight Summer Camp 2017
        Information received is confidential and is being gathered for the purposes of serving your child while in the 
        care of Ontario Christian Assembly Inc. Any medical information collected here serves to authorize Ontario 
        Christian Assembly Inc., and its staff and volunteers, to obtain medical assistance in emergencies.
        This form must be completed and signed in order for a child to attend Ontario Christian Assembly.
        Parents’ Names _________________________________ _________________________________
        Appendix 12 - In the case of custody agreements, please include the proper form authorizing parental/custodial
        contacts.
        Child’s Name _____________________________________ Date of Birth _____________________
        Grade in Fall _______________
        Address ___________________________________________________________________________
        Phone Number ______________________   Parents’ Work Number ____________________________
        Health Card Number __________________________ Parents’ Cell Number ______________________
        Family Doctor ________________________________ Doctor’s Phone Number ______________________
        Allergies ________________________________________________________________________
        Does your child have any life threatening allergies that could cause              Yes      No
        Anaphylactic Shock, requiring use of an EpiPen? If Yes, please call or email for information and forms for 
        Individual Anaphylactic Plan (Appendix 13)  Business phone: (905) 776-3847, email:   info@ocainc.ca 
        In case of an emergency, contact:   ______________________________________________
                                  Phone/Cell:  __________________________________
        Does your child have any physical, emotional, mental, behavioural                    Yes      No
        concerns or limitations that staff should be aware of?
        If yes, please explain:
        ________________________________________________________________________________________
        ________________________________________________________________________________________
        ________________________________________________________________________________________
        ________________________________________________________________________________________
        ________________________________________________________________________________________
                                                                                                                         3
                                                                                                             Appendix 9
        Is your child bringing any medication with him/her?                                  Yes      No
        If yes, please list. 
        ___________________________________________________________________________
        ___________________________________________________________________________
        The safety of your child is our primary concern.  Precautions will be taken for their well-being
        and protection.
        I/we, the parents or guardians named below, authorize Dean or one of the Ontario Christian Assembly Inc. 
        Ministry Personnel to sign consent for medical treatment and to authorize any physician or hospital to provide 
        medical assessment, treatment or procedures for the participant named above.
        I/we, named below, undertake and agree to indemnify and hold harmless Ministry Personnel, Ontario Christian 
        Assembly Inc., its Deans and Board of Directors from and against any loss, damage or injury suffered by the 
        participant as a result of being part of the activities of Ontario Christian Assembly Inc., as well as of any 
        medical treatment authorized by the supervising individuals representing the Camp.  This consent and 
        authorization is effective only when participating in or traveling to/from events sponsored by the Ontario 
        Christian Assembly, Inc.
        Photos
        Please sign below to grant permission for the reasonable use of pictures containing your child in any or all of 
        the following ways:
         Brochures/Promotional material                             Camp
         Website                                                    Newsletters
         Videotaping
        Purposes and Extent
        Ontario Christian Assembly, Inc. is collecting and retaining this personal information for the purpose of enrolling
        your child in our programs, to assign the camper to the appropriate classes, to develop and nurture ongoing 
        relationships with you and your child, and to inform you of program updates and upcoming opportunities at our 
        Camp.  This information will be maintained indefinitely as it is a requirement of our insurance company and 
        legal counsel.  If you wish Ontario Christian Assembly, Inc. to limit the information collected, or to view your 
        child’s information, please contact us.
        I have read, understood and agree with the above.
        Parent/Guardian Signature ___________________________________________________________
                                                                                                                        4