Registering online is faster and more efficient, payment must still be made. After registering online, a cheque or money order must be mailed separately to ensure the reservation of your child's spot. Please make all cheques payable to "Long Lake Camp" and mail them to:

Troy Smith
PO Box 203
Brooklyn NS B0J 1H0
Phone 298-9054
Email smithtd02@gmail.com

Download Registration Form in PDF form here (0.5MB download)

*	Camp Date	Please Choose Ages 14-17 - July 7-12 Ages 12-14 - Jul 14-19 Ages 10-12 - Jul 21-26 (Jr 1) Ages 8-10 - July 28-Aug 2 (Jr 2) Ages 5-7 - Aug 4-6
*	First Name
*	Last Name
	Camper's Email Address
*	Gender	Please ChooseMaleFemale
*	Age
*	Grade next Fall	Please Choose Pre-K K 1 2 3 4 5 6 7 8 9 10 11 12
*	Birth Date	Select Month January February March April May June July August September October November December / / 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
	Preferred Cabinmate
	Special Requests or Health Concerns	Please use no more than 500 characters.
*	Address
*	City
*	Province	Please Choose Nova Scotia New Brunswick Prince Edward Island Other
*	Postal Code
*	Home Phone	Please include dashes & spaces.
*	Work Phone	Please include dashes & spaces.
*	Email Address
*	Confirm Email Address
*	Parent Name
*	Emergency Contact Person
*	Emergency Cell Phone	Please include dashes & spaces.
	Other Emergency Phone	Please include dashes & spaces.
	Please list 3 adults authorized to pick up camper:	1. 2.  3.
	How did you first learn about our camps?	Please Choose Read a brochure Searched the web Link on Church website Heard about it from a friend/neighbour Received a flyer at school Saw a newspaper advertisement Heard an announcement at a church Picked up a displayed brochure
	School Name
Medical Information and Special Needs Personal physician: Physician's phone: Health insurance company: MSI number and expiry date: Medical problems of which the camp staff should be aware: Allergies (describe symptoms and treatment) The child carries an epipen: Yes No The child's Measles immunization is up to date: Yes No The child's Mumps immunization is up to date: Yes No The child's Rubella immunization is up to date: Yes No Chicken Pox information: Child has had chicken pox Child has not had chicken pox Child has been vaccinated against chicken pox Date of child's last tetanus shot: Is your child on any regular medication? If so, what is it and how is it administered? If we need to oversee your child taking it, please provide the details. Has you child been diagnosed with any sort of behavioral or physical disability? If so, please describe it and suggest strategies you've found effective. Does your child require a special aide or some sort of special consideration at school? Please explain. Is there something in your child's life that might impact his or her experience at camp (an unusual family situation, difficulty in reading or writing, a physical problem or recent illness, a fear of the dark, etc.)? Please describe. We have specific concerns about our child and would like camp staff to contact us. Yes No Camper's swimming ability: Please Choose Non-swimmer Beginner Intermediate Strong swimmer
I hereby give permission for the child noted above as "Camper" to participate in the programs noted above sponsored by the Long Lake Camp. It is understood that Long Lake Camp is a non-profit, charitable organization  and is not responsible for expenses or damages resulting from injury to participants or spectators which is sustained in conjunction with or incidental to camp. Accordingly, the undersigned HEREBY EXPRESSLYAGREE to waive all claims against, and hold exempt from liability, Long Lake Camp, its officers, directors, coaches and any other person affiliated with the camp, for injury or injuries sustained by the above referenced child, from whatever cause, while attending, participating in, or traveling to or from the camp.
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