LaunchTrack

Female Camper Early Bird 540.00 + 5% = - $567.00

Male Camper WAITLISTED - fill out form to be put on waitlist - $0.00

Method of Payment:

PLEASE ONLY PURCHASE 1 REGISTRATION TICKET AT A TIME. IF YOU HAVE MULTIPLE KIDS, CHOOSE ONE TICKET AND FILL OUR THEIR INFORMATION INDIVIDUALLY.

HIGHS CAMPER'S INFORMATION

First name:

Last name:

Camper's Legal Name:

Grade September 2026:

Age (as of July 12th):

Birthdate (yyyy-mm-dd):

At birth my physical/biological sex was:

Care Card Number:

Returning Camper?:

What team were you on last year?:

Current Home Church:

We do our best to put campers in a cabin with at least ONE friend. Please enter requests here (multiple names on a line will not be accepted)

Cabin Mate 1:

Cabin Mate 2:

Are you currently apart of any community or school sports teams? If yes, please list them here:

PARENT/GUARDIAN INFORMATION (EMAIL PROVIDED WILL RECEIVE ALL COMMUNICATION)

Parent/Guardian Name:

Parent/Guardian Cell Phone Number:

Email:

Address:

Address2:

City:

Province / State:

Postal / Zip Code:

Horseshoe Bay Ferry Pick-up/Drop-off Required (Nanaimo Island side ONLY):

MEDICAL INFORMATION

Emergency Contact Name:

Emergency Contact Relation to Camper:

Emergency Contact Phone Number:

Medical Concerns - Explain:

Medications?:

List All Medications and dosage:

Allergies?:

List Allergies:

Does the camper require an Educational Assistant while at school?:

Does the camper have any mental, emotional or behavioral designations or conditions (such as anxiety disorders, ADHD etc.) that we should know about?:

If yes, please describe the type of support needed:

SPONSORSHIP

If you wish to be sponsored, you will need to reach out to your church to receive a promo code FIRST. This promo code is used on the next payment page. This will be the only way for you to complete this registration form. *choose credit card as payment option, NOT check*