Summer Camp

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					                                                                                Office use only:_________________
                       2012 Winter Camp Registration                            Date Rcvd:____________ mail    fax
                                                                                courier      SC________________


Camper Information
Family Name                          First Name                           Nick-Name (if any)
Sex                □M □ F            D.O.B.           Y   M      D        Height            cm       Wt.         kg
School                               Grade completed
                                     Has been to Camp Taiwan’s Camp
Swim ability       □Y □N             before?                                 □Y year(s) attended                 □N

Parent / Guardian Information
Name                                              Relationship                 Cell Phone
Address
Phone Number                                                                   Daytime Phone
Email
Emergency
                                                  Relationship                 Phone #
Contact
How did you learn about Camp Taiwan (circle one)
Print Ad in ___________, on TV, Facebook, Yahoo, Google, MSN, other ___________
I would like my child to stay with                            (only 1 other and request must be mutual)

Session Dates
□ Session 1 (01/18~01/20)                         □ Session 2 (01/27~01/29)        □ Session   3 (01/30~02/01)
□ Session 4 (02/02~02/04)                         □ Session 5 (02/05~02/07)


Camp Fee and Remittance
□ Sign up before 11/1, early bird discount rate: NT$7,800 per session
□ Sign up for 2 sessions, discount rate: NT$8,000 per session
□ 2-9 campers group sign up discount rate, NT$8,000 per person per session
□ Regular Session NT$8,500
** You can only choose one discount rate to apply. Group discount’s deadline is before 2011/12/31.
Total amount (if you purchase a water bottle or a hat, please remember to add that up):___________NT

Camp Taiwan ATM Wire Transfer Information
ATM bank transfer: Our bank code (Mega Bank) is 017; The account # is 067-09-01638-6
Then please send a fax of the transaction record to Susan including your name, your child’s Name, their
session and your contact number. Fax : (02)7720-7725 attn: Susan



Conditions of Enrollment (please read Conditions of Enrollment before signing)

I have read, understand and agree to all sections of the conditions of enrollment.




Signature of Parent or Guardian_____________________ Date________________

                 Tel: (02) 7720-7721 Fax: (02) 7720-7725 Email: info@camptaiwan.com
                                    Camp Taiwan Health History Form
                                      Health history form for children attending Camp Taiwan.
                  Parents or staff should fill out this form. This form must accompany final payment.
      Camper Information
First Name:                                                       Last Name:

ARC / Passport No.:                                               (if differnt than from above):
Gender:        male     female              date of birth       (m/d/y)        /      /          Grade completed by winter____
School of grade completed                                         Age at camp time                 Years                  Months
      Custodial Parent / Guardian
Parent(s) / Legal Guardian(s) full (first and last)
Name(s):
Mailing Address

Home Phone           (     )                    Home Fax      (      )                  Home Email
Other authorized Parent/ Guardian
(if not living with child)                                                   Relationship
Emergency contact (other than
parent)                                                                      Telephone        (      )
Healthcare coverage by                                                       Policy #
      Insurance Information
      Does the participant have additional insurance coverage?   Yes         □
                                                                            No              □
      If so, indicate carrier plan or name__________________________ Group _____________________
      Carrier address_____________________________________________________________________
      Name of insured__________________________ Relationship to participant_____________________
      ID # of policy holder or insurance ID
      #_________________________________________________________
              Important – These boxes must be complete for attendance
   Parent/ guardian/ staff authorization: This health history is correct an complete as far as I know, and the person herein
   described has permission to engaging in all camp activities except as noted. I herby give permission to the camp to
   provide routine health care administer prescribed medications and seek emergency treatments including ordering x-
   rays or routine tests. I agree to the release of any records necessary for insurance purposes. I give permission to the
   camp to arrange necessary related transportation to me/ my child. In the event I cannot be reached in an emergency, I
   herby give permission to the physician selected by the camp to secure and administer treatment, including
   hospitalization, for the person named above. This completed for may be photocopied for trips out of camp.
   Signature of parent or guardian or adult camper/staff________________________________________________
   Printed name__________________________________________________ Date_______________________

   I also understand and agree to abide by any restrictions on my participation in camp activities.
   Signature of minor or adult camper / staff____________________________________________
   Date______________

      Allergies – list all known then describe reaction and management of reaction
       Medication allergies:


          Food Allergies:


          Other allergies:               Included bites, stings, hay fever, animals etc.




                        Tel: (02) 7720-7721 Fax: (02) 7720-7725 Email: info@camptaiwan.com
               Medications being taken
               Please list all medications (including over-the-counter or non-prescription drugs) taken
routinely. Bring enough medication to last the entire duration at camp. All medication must arrive in
the original package/bottle that identifies the prescribing physician (if a prescription drug) the name of
the medication, the dosage, the frequency of administration and its purpose.

   Medication Name                    Dosage               For treatment of:         Special Instructions




Restrictions: The following restrictions apply to this individual
Does not eat: □Red Meat □Pork □Dairy Products □Poultry □Seafood □ Eggs □
Other__________
Explain any restrictions to activities:




Has/does participant:                    Yes    No                                               Yes No
1. Had any recent injury or illness                   16. Ever had back problems
2. Have an Infections disease                         17.Ever had joint problems (knee ankle
                                                      etc)
3. Have a chronic or recurring                        18. Have an orthodontic appliance
illness/condition                                     being brought to camp
4. Ever been hospitalized                             19. Have a skin condition or rash
5. Ever had surgery?                                  20. Have diabetes
6. Have frequent headaches                            21. Have asthma
7. Ever had a head injury                             22. Had mononucleosis in past 12
                                                      months
8. Ever been knocked unconscious                      23. Have problems with bowels or
                                                      urinary tract
9. Wear glasses or contacts                           24. Ever sleepwalked
10.Ever had ear infection                             25. Have a history of bed wetting
11. Ever been dizzy or fainted                        26. Ever had an eating disorder
during exercise
12 Ever had seizures                                  27. (Females) have history of painful
                                                      menstruation
13.Ever had chest pain during or                      28. Ever had emotional difficulties for
after exercise                                        which professional help was sought
14. Ever had high blood pressure                      29. Have learning disability
15. Ever been diagnosed with heart                    30. Been diagnosed ADD or ADHD
murmur

Please explain any yes answers here:




                Tel: (02) 7720-7721 Fax: (02) 7720-7725 Email: info@camptaiwan.com
Place appropriate checkmark indicating whether or not the participant has had:


TB Mantoux test: Date of last test__________________

                                   Positive Negative
                      Yes No

Measles                            Please make note of any additional information about the
                                   participant’s behavior and physical, emotional, or mental health
Chicken Pox
                                   about which the camp should be aware:
German measles

Mumps

Hepatitis A

Hepatitis B

Hepatitis C

Our camp staff will be acting as the primary care-taker of your child. Information below will help our
staff care for your child and help them have a good experience.

Please check all that apply to your child

□ Independent                □ self-controlled □ problem solver           □ passive
□ physically active          □ tends to lead   □ tends to follow           □ gets along in groups
□ accepts criticism          □ follows rules   □ helps others              □ tests boundaries
□ works best in small groups □ manages personal hygiene         □ easily frustrated

If there is anything else you would like to share with our staff that would help us take care of your child
please
let us know:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________




                Tel: (02) 7720-7721 Fax: (02) 7720-7725 Email: info@camptaiwan.com
                          Camper Transportation Form And Camp Store

Parents, Please fill out this form and return it by mail or fax at least 2 weeks prior to your child’s
session start date.

Camper’s Name:
Parent’s Name:
Session # :        1 □; 2 □; 3 □; 4 □; 5 □

Please be at the following location by instructions. Please check one of the following:

My child will take the Camp Bus from:
□ Sun Yat Sen Memorial Hall (gather at 7:45AM, buses leave at 8:00AM)
□ Taipei Train Station, Gate East 3 (gather at 8:15AM, buses leave at 8:30AM)
□ My child will arrive by Plane and needs airport pick up.

The last day of each session finishes at 4:30pm. The departure time from Camp is 5:00pm with an
arrival time between 6:00-6:30pm. My child(ren) will be dropped off at:
□ Sun Yat Sen Memorial Hall
□ Taipei Train Station, Gate East 3

If your child is flying to / from Taiwan or to Taipei and needs to be picked up or dropped off at an
airport, please fill in the information below.*
Arrival Flight #                 From:              Arrival Time:


Departure Flight              To:                  Departure Time:
#


*A copy of your child’s ticket must be faxed to the camp Taiwan office +886-2-7720-7725 at least one-
week prior to the session start date.
Children flying internationally must be booked as unaccompanied minors and this information must be
arranged between the parents and the airlines.

Camp Store
If you would like to purchase a Camp Taiwan water bottle, it must be pre ordered. Fill out the form
below and your child will receive the item when they arrive at camp.

Please fill out this form by checking the boxes as necessary, and add this cost to your camp fee and
fax it back with your registration form.

□ $500 BPA-Free                                                                  Total:_________




Eco-friendly metal
water bottle




                Tel: (02) 7720-7721 Fax: (02) 7720-7725 Email: info@camptaiwan.com
                     Camp Taiwan Winter- Camp Clothing List
All bedding, a towel and soap & shampoo are provided.



                         Clothing                                               Miscellaneous

Long sleeve shirts                        4                     1 Flash light or headlight and extra
                                                                batteries
1 camp shirt (provided)                                         1 Pocket-Size (3X5) lined notebook
Long pants (we do not recommend jeans)    4                     1 Pen/Pencil
Sweater or sweatshirt – Fleece is best    2                     1 UV Sunglasses
Underwear                                 5                     1 Water-bottle with strap/clip
Socks                                     5                     1 Toothbrush
Pajamas                                   1                     1 tooth paste
Running shoes/sneakers with firm sole &   2
support appropriate for hiking.
Rubber boots                              1                                Optional Items
Slippers for indoors                      1                     Letter-writing Materials & stamps
Rain coat                                 1                     Camera (& charger or batteries as
                                                                needed)
                                                                               Toiletry
                                                                Personal toiletry items (tooth brush,
                                                                Tooth paste – brush/comb, face cloth)

The following list of items are NOT allowed at camp and will be confiscated if found.
Camp is a place to enjoy the sights and sounds of nature. There will be enough activities without
needing electronic stimulation.
〤cell phones 〤radios/ MP3/ disk players/computers or any other electronic game or device

The safety and wellbeing of all our campers comes first.
〤aerosol cans〤firecrackers/lighters/matches or anything flammable 〤pocket-knives, scissors or any
other potentially harmful object

We will arrange for alternative meals for children with religious or medical food needs. There are
enough meals and snacks for campers without needing “extras”. Also, having food in the eco lodge
attracts unwanted attention from animals.
〤food (or drinks) 〤candy 〤chewing gum

Children caught vandalizing camp property will be sent home immediately and the replacement cost of
the vandalized property will be charged to the child’s parent or guardian.
〤spray paint 〤markers〤glue 〤cigarettes 〤alcohol

【Camp Taiwan Refund Policy】
Participants can cancel the camp before it starts, but Camp Taiwan will take a handling charge. The refund
standards are based on the declaration of Tourism Bureau of Ministry of Transportation and Communication.
                                                           st         th
1. The cancellation notice arrives Camp Taiwan from the 21 to the 30 day before starting, 90% of the
   payment will be refunded.
                                                            th           th
2. The cancellation notice arrives Camp Taiwan from the 11 to the 20 day before starting, 80% of the
   payment will be refunded.
                                                         th            th
3. The cancellation notice arrives Camp Taiwan from the 4 to the 10 day before starting, 70% of the payment
   will be refunded.
                                                         st         rd
4. The cancellation notice arrives Camp Taiwan from the 1 to the 3 day before starting, 30% of the payment
   will be refunded.
5. The cancellation notice arrives Camp Taiwan on the starting day, no refund.

                     Tel: (02) 7720-7721 Fax: (02) 7720-7725 Email: info@camptaiwan.com

				
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