Camper Application Form

Name:
Address
City
Province
Postal Code
Gender
Birth Date
Age
I wish to attend Junior Camp - Ages 8-11 (July 6 - 11) $220 (if registered before May 1) (July 6 - 11) $245 if registered after May 1) (July 27 - Aug 1) $220 (if registered before May 1) (July 27 - Aug 1) $245 (if registered after May 1)
Young Teen Camp - Ages 11-14 (July 13 - 18) $245 (if registered before May 1) (July 13 - 18) $270 (if registered after May 1) (Aug 3 - 8) $245 (if registered before May 1) (Aug 3 - 8) $270 (if registered after May 1)
Senior Teen Camp - Ages 15-18 Aug 17-21 $180 (if registered before June 1) Aug 17-21 $205 (if registered after June 1)
Please mark T-shirt size: All prices include GST
Youth Small Medium Large X-Large
Adult Small Medium Large X-Large
Any pictures of my child at camp may NOT be used for promotional purposes.
I would like a DVD of my child's camp experience at an additional cost of $10.
Refunds will be given minus a $50.00 non-refundable fee A $50 pre-registration fee is to accompany each application. The balance of fees is due at registration. No posted-dated cheques, please.
Sask Health #:
Doctor's name:
Phone Number:
Does the camper suffer from any medical/emotional condition that may restrict normal activities including land and water sports? Are there any medical/emotional conditions that we should be aware of? Yes No
If Yes please explain
Allergeies	Yes No
If yes please explain:
Current Medication:
Parent/Guardian can be reached at:
Name:
Phone:
In case of emergency, if parent/guardian can not be reached contact
Name:
Phone
Do we have permission to obtain medical treatment in an emergency when a parent or guardian cannot be reached? Yes No
To the best of my knowledge, the applicant camper is in good health. Yes No
Name of parent guardian
Parents / Guardian Email Address to confirm receipt of registration.
Payment Options	Cheque Call with your Credit Card Pay online with your Credit Card/Paypal