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Referral Information
CHILDREN AGES 7-14 APPLICATIONS BY MAIL ONLY
Mission Statement
The Stevenson Children’s Camp is committed to providing a fun-filled, safe
and memorable camp experience for children who would not otherwise
have an opportunity to attend summer camp.
Attention: Referring Schools, Agencies and Individuals
Enclosed is the APPLICATION FORM for Stevenson Children’s Camp (you may copy as many forms as
needed by your school or agency). This is typically a residential camp located on Gore Road, east of
London. The camp is for children ages 7-14 whose families, to the best of your knowledge, are
experiencing difficult financial circumstances that would prevent their child from attending summer
camp. To provide this opportunity for the maximum number of children, campers can attend ONLY one
session.
Stevenson Children’s Camp is pleased to be able to continue to plan camp for the 2021 season with
enhanced COVID-19 protocols. We will be modifying our program to be a day camp instead of our
traditional overnight. It is our hope that if we plan to run day camp the campers will still have an
opportunity to attend our program. The government has still not made it clear if residential camps
will be allowed to operate for this season and the shift to day camp will give us the highest chance to
be able to operate.
Registration Process
You must complete the referring school or agency section (part 3) of the application, then may
photocopy with the parent information letter for distribution to selected children ages 7-14 that you
believe fit the criteria. Our primary mission is to provide a positive summer camp experience for
children who would not otherwise have this type of opportunity. We attempt to meet all campers’
needs socially, emotionally and/or otherwise. Please keep this in mind when referring children who
exhibit higher needs that require additional supervision. We do not have the capacity for one-on-one
supervision. If you have any questions regarding campers needs, please contact the camp at 519-268-
7235. Applications will not be processed without the completed referral section.
Applications are by mail and email only and are processed on a first come, first served basis. The
registration fee will be completely waived this season as we want to ensure that the opportunity is
available for as many campers as possible. We offer eight sessions, running from Monday to Friday
throughout the summer.
Transportation
The impact of COVID-19 limits our ability to provide transportation. To ensure safety of the campers
and sustainability of the camp we will not be able to provide transportation this season. Parents/
guardians must arrange transportation for their child(ren) to and from camp every day. We
understand that this may pose a challenge and are working to be flexible with drop off and pickup.
Parent Information
CHILDREN AGES 7-14 APPLICATIONS BY MAIL ONLY
Mission Statement
The Stevenson Children’s Camp is committed to providing a fun-filled, safe
and memorable camp experience for children who would not otherwise have
an opportunity to attend summer camp.
Dear Parent or Guardian,
Your child has been selected to receive an APPLICATION FORM for Stevenson Children’s Camp. This is a
residential camp for children age 7-14 whose families are experiencing difficult financial circumstances that
would prevent their child from attending summer camp. To provide this opportunity for the maximum
number of children, campers can attend ONLY one session.
Day Camp Model
Stevenson Children’s Camp will be running a day camp for the season of 2021 to increase the likelihood that
we will be able to operate for the summer of 2021. This will mean that you drop your child off any time
after 7:30am (official drop off 7:30-8:30am) and will have to be picked up no later than 5:30pm. We will be
flexible to ensure that parents are able to work within their capabilities while still providing camp for the
children.
Transportation
COVID-19 has limited our ability to provide transportation. To ensure safety of the campers and
sustainability of the camp we will not be able to provide transportation this season. Parents/ guardians
must arrange transportation for their child(ren) to and from camp every day. We understand that this may
pose a challenge and are working to be flexible with drop off and pickup. To help support families with this
shift we will not be charging any fees for this season and allowing families flexibility in who is picking
campers up.
Food
Families will need to send their campers a lunch similar to school. COVID-19 regulations make it
unsustainable to provide food for campers this season. Please speak with your camper to ensure they
understand that they will not be able to share foods with other campers. If your child has a food allergy,
please ensure that the camp is aware of it on the registration form.
Day Camp Highlights
Stevenson Children’s Camp is working closely with our local health unit to ensure we are meeting the
highest level of safety protocols for COVID-19. Our goal is to find the proper balance between COVID-19
safety and camper fun. This means that we will be constantly evaluating and updating our protocols as new
information is available. As a camp family you can ensure that all possible protections will be in place to
maximize child safety.
At the time of creating these forms every camper group will have its own dedicated councilors to ensure
there is no crossover between staff. We are asking parents to please notify the camp if siblings will be
attending so that we can have them in the same group. If this is not possible for families, please try to have
siblings in separate weeks.
Day Camp Highlights Cont.
Our cohort sizes will be limited to 12 campers and 2 staff. This is going to allow us to effectively contact
trace any potential cases and quickly be able to move any potential symptomatic campers to our isolation
cabin while they wait for a guardian to pick them up. Families will be asked to complete daily screening
upon drop-off.
Camp staff will be completing enhanced cleaning procedures throughout the day. We have already divided
the site to allow cohorts to have their own areas/ washrooms with limited crossover. Extra procedure will
be included as require and communicated with parents as needed. As we approach the start of camp, we
will have updated procedures available on our website.
Registration Process
To avoid delays and allow us to accurately predict numbers for the summer please ensure all steps are
followed and that you submit as quickly as possible.
It is important to complete all sections of the application form
No applications will be processed without the referral section completed by a school or agency
This year we will be accepting mailed and digital applications (please understand that this will be
the first time accepting digital applications).
Applications are accepted on a first come, first served basis
Registration fee has been completely waived this season
Digital copies can be emailed to Stevensonchildrenscamp@gmail.com (please complete following
steps)
1- Please can a copy of all page in a PDF format.
2- Email copy to Stevensonchildrenscamp@gmail.com
3- In the subject line please use Registration 2021- (child’s name)
4- Every child should have a separate email to keep forms straight.
Registrations to be forwarded by mail to: Stevenson Children’s Camp
P.O. Box 39020
London, ON
N5Y 5L1
A confirmation letter will be sent by e-mail with a complete camper check list, session date, drop off and
pick up procedures and contact information. If you require a mailed copy, please ensure you mark it on the
form.
PLEASE NOTE THAT STEVENSON CHILDRENS CAMP ENDEAVORS TO HAVE ALL CAMPERS HAVE A SUCCESSFUL FUN
FILLED WEEK. IF THE DIRECTOR OR EXECTUTIVE DIRECTOR OF THE CAMP FEEL AT ANY TIME THE CONDUCT OR
BEHAVIOR OF A CAMPER IS PUTTING THE CAMPER THEMSELVES OR OTHER CAMPERS AT RISK YOU WILL BE
ASKED TO PICK YOUR CAMPER UP AND THEIR CAMPING EXPERIENCE WILL END. FAILURE TO COMPLY WITH THIS
REQUEST MAY RESULT IN POLICE BECOMING INVOLVED.
Camp Subsidy:
Stevenson Children’s Camp provides subsidy to all campers. This is the reason that no applications will be
accepted without the referral filled out. The TRUE COST OF CAMP is close to $400.00 and the camp works
very hard to secure funds so that no family pays more than $20.00. We ask that if families feel they can pay
more than $20.00 that they consider making a donation to help support future projects and growth of the
camp. DONATION information can be found on our website.
Camper Application Form
Please use ONE application PER Camper
FOR YOUR CHILD’S APPPLICATION TO BE CONSIDERED
ALL REQUESTED INFORMATION MUST BE PROVIDED
(Health Card # and emergency contact information MUST be
completed)
Part 1: Contact Information—Completed by Parent/Guardian
Camper—Full Name: __________________________________________________ Male Female
Camper—Name commonly used (if different than above): ___________________________________________
Date of Birth: (M)_________ (D)__________ (Y)________Age (as of June 30 2021): ____________________
Name of School camper attend: ________________________________________________________________
Has your child attended Stevenson Children’s Camp before? Yes No Do you have other child(ren)
attending camp this year? Yes No Full Name________________________________________________
Parent/Guardian Names: _______________________________________________________________________
Address: ______________________________________________City: __________________________________
Postal Code: _____________Email Address (for confirmation): _________________________________________
In an effort to keep cost low we will be attempting to email confirmation please check here if you would like a
hard copy mailed.
Primary Contact Information: Name: ____________________ Telephone: _____________________________
Secondary Contact Information: Name: ____________________Telephone: _____________________________
Emergency Contact Name:______________________________ Telephone: _____________________________
Additional persons authorized to pick up your child from camp:
__________________________________________________________________________________________
__________________________________________________________________________________________
***On occasion the camp has promotional events which may require photographs.
***Please indicate whether you grant permission for your child to be included. Yes No
In order for Stevenson Children’s Camp to provide the camp experience for the maximum number of children
st nd rd
each summer, campers can attend ONLY one session. Please indicate 1 , 2 and 3 choices. Please note that all
efforts will be made to secure priority weeks but it is not always possible
Session 1 Session 5
Monday July 5-Friday July 9 Monday August 2-Friday August 6
Session 2 Session 6
Monday July 12—Friday July 16 Monday August 9–Friday August 13
Session 3 Session 7
Monday July 19—Friday July 23 Monday August 16—Friday August 20
Session 4 Session 8
Monday July 26—Friday July 30 Monday August 23—Friday August 27
Parent/Guardian Signature: _______________________________________ Date: __________________
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