Adult Health Record 2020

Before you start... We have some important information for you.

Camp Trillium acknowledges that your family's personal health information is very sensitive. As such, we are obliged to inform you of the inherent risks associated with sending any personal health information online.

At Camp Trillium, we are committed to protecting your privacy, and will take extra precautions to ensure that the information you provide us will not be shared outside our organization, and only with authorized persons. We will also comply with applicable Canadian Laws, including PHIPA (Personal Health Information Protection Act) and PIPEDA (Personal Information Protection and Electronic Documents Act) when collecting and handling your personal health information. Unfortunately, all technology is susceptible to unlawful intrusions or leaks, regardless of the steps taken, and ours is no different. Because of this, and while we feel that your information is safe with us, we cannot guarantee that your information will be protected from unlawful intrusion.

For your information, here are the steps we are taking to protect your privacy online:

  • Our website uses an SSL Certificate with both 128-bit and 256-bit protection (depending on which browser you are using). SSL is the standard technology for protecting your privacy while you are browsing. Our website will force you to use SSL while browsing, however, in some cases, if your browser does not recognize our certificate, it may still allow you to view our site, which could pose a security risk. To check if you're protected, look for the  green padlock in your address bar. Although SSL is the security standard for websites, and while breaches on SSL-protected websites are difficult and extremely rare, it can still happen. To further protect yourself, you should only use this form on a trusted, private Internet connection, such as a home network.
  • After completing your form, your information will never be distributed by email, and we have placed limits on the ways your information can be accessed. Once your form has been processed, we will not store your information online for any longer than necessary. Because of the nature of computer technology, your information may be stored or transmitted in regions outside of Canada.
  • In case of a data breach, we are always vigilant and ready to act to determine the source and cause of the breach, and will comply with all applicable laws, including PHIPA and PIPEDA, to mitigate any damage that may have been caused.

Because of these privacy concerns, in accordance with PHIPA and PIPEDA, we cannot require you to send us your health information electronically, and so we provide you with two options:

If you don't want to use our electronic form...

We will still provide you with copies of our medical forms as a PDF. Click here to download this form, print it out, fill in all the spaces, and mail it to our office.

To continue with our electronic form...

Before you can continue, we need you to read the above, and understand the potential risks. You are welcome to call us at 1-888-999-2267 and ask us any questions before continuing.

We will send a confirmation of receipt to this email address. For security reasons, we will not email you the contents of this form.