CAMPER REGISTRATION FORM 2008
Please register one camper (Junior/Teen) or one family (Family Camp) per form.
Be sure to pre-register at least two weeks in advance as there is only room for a limited number of campers per week. All campers will be accepted on a first-come, first-serve basis.
Name: (First)___________________________ (Last)___________________________
_____ Male _____ Female Birth date: _______________________
Address: ____________________________ Town: ___________________________
Province: ____________________________ Postal Code: ______________________
Phone: (Home)_________________________ Phone: (Work)______________________
E-mail: (optional) ____________________________
Band Name:_________________________________________
Treaty Number: ______________________________________
Camper wishes to come for:
_____ Week 1: July 6 - 11 (8-12 years)
_____ Week 2: July 13 - 18 (8-12 years)
_____ Week 3: July 20 - 25 (8-12 years)
_____ Week 4: July 27 - Aug. 1 (8-12 years)
_____ Teen Camp: Aug. 3 - 8 (13-17 years)
Family Camp Only: Number of people in family attending ______
Camp Fees:
$90.00 -- Registration Fee (8-12 years)
$100.00 -- Registration Fee for Teen Camp (13-17 years)
$______ -- Registration Fee for Family Camp (Adults $40; Teens $25; Children $25; Under 5 free)
$______ -- Total Fees enclosed
MEDICAL INFORMATION:
Sask. Health Card No. ______________________________
List any allergies of the camper(s): _____________________________________
________________________________________________________________
List any medications being used by the camper(s):___________________________
_________________________________________________________________
Are the tetanus injections up-to-date for the camper(s)? Yes ___ No ___
Describe any health problems, handicaps or illnesses that staff should be aware of:
___________________________________________________________________
If we cannot reach you in case of an emergency, who should we call?
Name _______________________________ Phone _________________________
I promise to obey all camp rules (camper should sign below ... must be signed for camper to be registered)
____________________________________________
Parents Consent:
By signing , I approve of my child's/family's attendance and involvement in the program at Pine Ridge Bible Camp. I understand that NCEM reserves the right to use pictures taken of my child/family at this camp in promotional material. I release the Camp from all blame for any illness or injury to my child/family while at camp. I understand that in case of a medical emergency every reasonable effort will be made to contact me. If I cannot be reached, I give permission to the physician selected by the Camp staff to provide treatment for my child/family.
Signed _________________________ Name of Parent/Guardian (please print) _______________________
(Must be signed for Camper/Family to be registered)