Jump-In Camps

Summer Camps

Jump In is excited to bring back to Canby Grove Christian Center the much loved tradition of Summer Day Camps. We have 6 weeks of camps planned full of activities to keep your child entertained. Each week will be jam packed with activities that will include swimming, water games, field activities, crafts and much more all incorporated into the weeks theme. Every week will feel like a new adventure.
 
Camps are geared for 6–11 year olds who are going into the 1st through fifth grades
fall of 2013. Campers must have turned 6 years old before June 26th and enjoyed kindergarten for the 2012-13 school year.

Camper Health Form

Please complete this form for each individual who plans on attending. Each camper must be registered separately.

This is a Secure Form. Only essential personnel who will assist your camper with their health needs at camp will see this information. This form is separated from the original registration form you submitted. Some fields are duplicated from registration but needed on this form as well.  Your typed in Name on this form will take the place of a signature on a paper form. 

Name *
Name
Please add in Middle Name after First Name
Date of Birth *
Date of Birth
Home Phone *
Home Phone
Mother (Guardian) Phone Number *
Mother (Guardian) Phone Number
Mother (Guardian) Work #
Mother (Guardian) Work #
Father (Guardian) Phone Number
Father (Guardian) Phone Number
Father (Guardian) Work Number
Father (Guardian) Work Number
Emergency Contact *
Emergency Contact
IMMUNIZaTIONS
Immunizations are Current *
Date of Last Tetanus Immunization *
Date of Last Tetanus Immunization
ALLERGIES
Known Allergies *
Example: Allergy: Bees /Reaction: anaphylaxis or Allergy: Amoxicillin /Reaction: Rash
OVER THE COUNTER MEDICATIONS
Check any medications camper SHOULD NOT receive:
Please Type in Full Name (parent or guardian)
HEALTH CONCERNS
Mental/Emotional/Social Health Concerns: *
Medical History/Health Conditions *
MEDICATIONS
We are not able to administer or receive medications that are not in original packaging. Over the counter medications need to be accompanied with a physician prescription order. All medications should be in original packaging with the correct prescription label. Please only bring medically necessary medications to camp. Avoid bringing vitamins and nonessential medications. No camper is allowed to have medications in their cabin, or to self medicate without the supervision of the camp nurse. All medications are to be turned into the camp nurse upon arrival to camp.
MEDICATION #2
If you do not have any medications put N/A in box
DIET AND NUTRITION
Diet/Nutrition *
At JumpIn Camps we accommodate dietary needs gluten free diets and some accomodations can be made for lactose intolerance depending on the severity. A menu will be available for you to look over so you can better determine if you need to send special diet monitored food with your camper. We do not make accommodations for preferences.
ADDITIONAL INFORMATION
We desire to make the camp experience easy and enjoyable for your child. Any information you can give us that would help us in knowing what extra care we may need to have available, including staffing, is helpful in ensuring your campers enjoyable camp experience.
Type in Full Name in place of Signature

info@jumpincamps.com

503.266.5176

Canby Grove Christian Center   7501 S Knights Bridge Rd, Canby, OR  97013