2016 summer registration form - 2016 summer registration form discover. develop. lead. we are...

Download 2016 Summer Registration Form - 2016 Summer Registration Form Discover. Develop. Lead. We are excited

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  • Page 1

    PLEASE RETURN THIS FORM WITH PAYMENT TO: ADULLAM CAMPS 24 ELGIN STREET EAST CONESTOGO, ON N0B 1N0

    226-799-9813 REGISTER@ADULLAM.CA

    WWW.ADULLAM.CA

    2016 Summer Registration Form

    Discover. Develop. Lead. www.adullam.ca

    We are excited for another summer of Adullam adventure! There are so many wonderful camps and activities happening all summer long. Please review the information in this registration package, select the camp(s) you are interested in and carefully complete the registration form provided. We want to ensure your registration form is processed properly.

    For all other camp related information, please visit us online at www.adullam.ca

    Note: Each registration must include the completed registration form, health form and payment.

    2016 LEADER-IN-TRAINING PROGRAM

    2016 LIT DATES 2016 LIT PROGRAM AGES / GRADES LIT – SUPER EARLY-BIRD LIT – EARLY-BIRD GENERAL * * * *ENDS MARCH 31ST *ENDS APRIL 30TH *BEGINS MAY 1ST

    STARTS JULY 1 LEADER-IN-TRAINING (4-WEEK SESSION) YOUTH GOING INTO GR. 10 -11 $1,160 $1,290 $1,550 STARTS JULY 1 LEADER-IN-TRAINING (3-WEEK SESSION) YOUTH GOING INTO GR. 10 -11 $900 $1,000 $1,200

    2016 SUMMER CAMPS LISTING

    2016 DATES 2016 CAMPS LISTING AGES / GRADES SUPER EARLY-BIRD EARLY-BIRD GENERAL * * * *ENDS APRIL 30TH *ENDS MAY 31ST *BEGINS JUNE 1ST

    JULY 10 – 15 BIKE, HIKE & PADDLE GRADES 7 – 10 $370 $410 $490 JULY 17 – 22 ALGONQUIN ADVENTURE GRADES 7 – 10 $370 $410 $490 JULY 27 – 30 FRENCH CAMP GRADES 3 – 10 $320 $350 $400 JULY 27 – 30 JUNIOR CAMP GRADES 3 – 8 $320 $350 $400 AUGUST 1 – 5 MUSIC DAY CAMP GRADES 3 – 10 $100 $115 $145

    AUGUST 7 – 12 ART, MUSIC, DANCE & DRAMA – OVERNIGHT GRADES 4 – 10 $370 $410 $490 AUGUST 7-12 ART, MUSIC, DANCE & DRAMA – DAY CAMPER GRADES 4 – 6 $300 $330 $400

    AUGUST 7 – 12 COOKING CAMP GRADES 3 – 7 $370 $410 $490 AUGUST 12 – 14 FAMILY CAMP ALL-AGES FAMILY $130 / SINGLE $65 FAMILY $150 / SINGLE $75 FAMILY $190 / SINGLE $95 AUGUST 14 – 19 HOCKEY CAMP GRADES 4 – 9 $510 $560 $670

    AUGUST 20 – 27 CHORAL CAMP – OVERNIGHT ALL-AGES, FAMILIES WELCOME CAMPER $410 / PRIMARY $110

    CAMPER $460 / PRIMARY $110

    CAMPER $550 / PRIMARY $110

    AUGUST 20 – 27 CHORAL CAMP – DAY CAMPER ADULTS CAMPER $350 CAMPER $390 CAMPER $470

  • Page 2

    PLEASE RETURN THIS FORM WITH PAYMENT TO: ADULLAM CAMPS 24 ELGIN STREET EAST CONESTOGO, ON N0B 1N0

    226-799-9813 REGISTER@ADULLAM.CA

    WWW.ADULLAM.CA

    DISCOUNTS Family Discount – The first family member registered pays full price, however each subsequent family member receives a 20% discount.

    Multi-Camp Discount – If you register for more than one camp this summer, you pay the full price on the first camp and receive a 20% discount on each subsequent camp you attend (same camper only).

    PAYMENT OPTIONS CHEQUE: Please include your payment by cheque along with your registration form and health form. Cheques should be made out to: Adullam Camp Ministries. There is a $35 NSF fee.

    Option 1: Include full payment with registration. Option 2: Minimum deposit of $100 per camper per event due with registration and include a post-dated cheque for the balance due by June 30, 2016.

    CREDIT CARD – VISA or Mastercard: This option is only available for online registrations.

    Send your registration forms with full payment, or your $100 registration fee plus a post-dated cheque for the balance due before June 30th to:

    Adullam Camps Attention: Registrar 24 Elgin St. E. Conestogo ON N0B 1N0 register@adullam.ca

    REFUND AND CANCELLATION POLICY The registration fee is non-refundable after June 15th. In case of a camper cancelling attendance after June 30th, no monies will be refunded. An information packet will be sent shortly after receipt of registration. If you do not receive an information package before June 30th, please contact the registrar at register@adullam.ca

    FINAL CHECKLIST □ Registration Form □ Health Form □ Did you indicate your options for

    Art, Music, Drama & Dance camp?

    □ Did you fill out your options for Choral Camp? (adult campers only)

    □ Did you order your camp shirt and choral camp CD? □ Did you take advantage of our discounts? □ Payment enclosed

  • Page 3

    PLEASE RETURN THIS FORM WITH PAYMENT TO: ADULLAM CAMPS 24 ELGIN STREET EAST CONESTOGO, ON N0B 1N0

    226-799-9813 REGISTER@ADULLAM.CA

    WWW.ADULLAM.CA

    CAMPER REGISTRATION FORM

    REGISTRATION INFORMATION Please indicate the week(s) you are registering for: (see attached sheet for information)

    Camp Camp

    Dates Dates

    Fee Fee

    CAMPER PERSONAL INFORMATION First name Last name

    Date of birth Grade (as of 2016-2017 school year)

    Gender: M / F

    Email address Participant’s Email

    Home phone number Cell phone number

    Address

    Address 2

    City Province/State

    Country Postal Code/Zip Code

    Shirt Size – $15 (circle which applies) Adult – S / M / L / XL / XXL Child – S / M / L / XL

    Sweatshirt Size – $30 (circle which applies) Adult – S / M / L / XL / XXL Child – S / M / L / XL

    One Mutually Agreed Upon Cabin Mate

    List any food allergies/needs

    Other Comments or Concerns

    PARENT/GUARDIAN QUESTIONS First name Last name Gender M / F

    Date of Birth Email address

    Home phone number Cell phone number

    Business phone number

    Address

    NOTE: Choral Camp and Art, Music Dance & Drama Camp registrants only: If you are registering for one of these camps you must complete the information on page 5 and/or 6 of this package.

  • Page 4

    PLEASE RETURN THIS FORM WITH PAYMENT TO: ADULLAM CAMPS 24 ELGIN STREET EAST CONESTOGO, ON N0B 1N0

    226-799-9813 REGISTER@ADULLAM.CA

    WWW.ADULLAM.CA

    PAYMENT CALCULATION

    Camp Registration Fee $ See attached sheet for fees

    T-shirt (optional): $15.00 $ Indicate Size: S M L XL

    Sweat Shirt (optional): $30.00 $ Indicate Size: Adult: S M L XL

    Choral Camp CD (optional): $10 Will be distributed after camp

    Donation (optional) $

    Discounts:

    Family Discount $ See attached sheet for details

    Multi-Camp Discount $ See attached sheet for details

    TOTAL $

    WAIVER AND CONDITIONS OF ENROLMENT 1. I, as a parent or guardian, have legal custody of the applicant camper and certify that the applicant is in good

    physical and emotional health, and amendable to normal camp authority.

    2. The Camp Director reserves the right to dismiss a camper who in his/her opinion is a hazard to the safety and rights of others, or who appears to have rejected the reasonable controls of camp.

    3. I, as the parent or guardian of the applicant, release Adullam Camp Ministries, its directors, staff and agents from any loss, personal injury, accident, misfortune or damage to my child and his/her property, with the understanding that reasonable precautions shall be taken to ensure the health and safety of the camper. Ontario Health Insurance or equivalent medical insurance must cover each camper.

    4. Permission is given for my child to participate in all Adullam Camp Ministries activities. Images of camp activities may be used for promotional purposes.

    5. Permission is given to provide normal medical attention to my child as needed, including the administration of over-the-counter medication by the health care staff at his/her discretion. I also give permission to the physician selected by camp officials to secure proper treatment including hospitalization, injection, anesthesia or surgery for this minor. The parents/guardians are responsible for additional expenses that may result from such services.

    6. I have read and understand this application form and I accept the conditions of enrolment.

    Parent/Guardian Signature Date

  • Page 5

    PLEASE RETURN THIS FORM WITH PAYMENT TO: ADULLAM CAMPS 24 ELGIN STREET EAST CONESTOGO, ON N0B 1N0

    226-799-9813 REGISTER@ADULLAM.CA

    WWW.ADULLAM.CA

    The following two camps require specific information for registration.

    CHORAL CAMP REGISTRANTS – REQUIRED INFORMATION – ADULTS ONLY I will play hand bells – Yes / No

    I am bringing my: □ Tent □ Trailer □ RV □ Other accommodations I will share my tent / trailer / RV with

    ART, MUSIC, DRAMA & DANCE CAMP REGISTRANTS – TOP FIVE SELECTIONS Please select a total of 5 options from all options below and mark them in order of preference - 1, 2, 3, 4, A – where “A” is an alternate. And be sure to take a chance and try something new!

    □ Leader-in Training ONLY: Mandatory drama option – This box must be the #1 selection for all LIT’s. ART OPTIONS

    □ Water Colour Painting - Create beautiful paintings while practising your newly acquired skills in special effects, washes, specific brush strokes, colour mixing and more! □ Digital Imaging – Receive instruction in making your camera work for you to produce fantastic prints along with a few great effects using Photo Shop. □ Stained Glass (Grades 7 - 10) – Produce two and three dimensional products while studying design, colour selection, cutting, grinding, copper foil and soldering techniques. □ Pottery – Learn a variety of hand-building techniques along with specific decoration and glazing va

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