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PLEASE RETURN THIS FORM WITH PAYMENT TO:ADULLAM CAMPS24 ELGIN STREET EASTCONESTOGO, ON N0B 1N0
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 $95AUGUST 14 – 19 HOCKEY CAMP GRADES 4 – 9 $510 $560 $670
AUGUST 20 – 27 CHORAL CAMP – OVERNIGHT ALL-AGES, FAMILIES WELCOMECAMPER $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
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PLEASE RETURN THIS FORM WITH PAYMENT TO:ADULLAM CAMPS24 ELGIN STREET EASTCONESTOGO, ON N0B 1N0
WWW.ADULLAM.CA
DISCOUNTSFamily 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 CampsAttention: Registrar24 Elgin St. E.Conestogo ON N0B [email protected]
REFUND AND CANCELLATION POLICYThe 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 [email protected]
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
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PLEASE RETURN THIS FORM WITH PAYMENT TO:ADULLAM CAMPS24 ELGIN STREET EASTCONESTOGO, ON N0B 1N0
WWW.ADULLAM.CA
CAMPER REGISTRATION FORM
REGISTRATION INFORMATIONPlease indicate the week(s) you are registering for: (see attached sheet for information)
Camp Camp
Dates Dates
Fee Fee
CAMPER PERSONAL INFORMATIONFirst 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 QUESTIONSFirst 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.
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PLEASE RETURN THIS FORM WITH PAYMENT TO:ADULLAM CAMPS24 ELGIN STREET EASTCONESTOGO, ON N0B 1N0
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 ENROLMENT1. 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
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PLEASE RETURN THIS FORM WITH PAYMENT TO:ADULLAM CAMPS24 ELGIN STREET EASTCONESTOGO, ON N0B 1N0
WWW.ADULLAM.CA
The following two camps require specific information for registration.
CHORAL CAMP REGISTRANTS – REQUIRED INFORMATION – ADULTS ONLYI 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 SELECTIONSPlease 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 variations to produce beautiful unique pieces.
□ Wood-burning (Grades 7 - 10) – Learn the “burning basics” (including colour application), along with creating your own walking stick!
□ Drawing Nature – Learn the basics of drawing in nature while using a variety of mediums, along with some out-door drawing excursions.
□ Sculpture – Using every day household objects, learn to create your own unique piece of three-dimensional art, while studying various techniques in realistic and abstract sculpture in multiple mediums.
□ Card Making – Using specialty papers, design your own card and learn fold and seam cutting, colour enhancement, stamping, embellishments, and more!
□ Masterpiece Mixed Media – Enjoy trying something new each day to produce specific techniques as you learn to use chalks like Chagall, painting patterning with stencils like Matisse, Impressionism painting like Manet, abstract expression, and much more! A new discovery awaits you as you create your own masterpiece using a different medium each day!
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PLEASE RETURN THIS FORM WITH PAYMENT TO:ADULLAM CAMPS24 ELGIN STREET EASTCONESTOGO, ON N0B 1N0
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DANCE & DRAMA OPTIONS
□ Dance, Movement, Exercise Bags, Flags and More – Create “pictures, images, colours, atmosphere and moods” by using moves and basic dance steps and enhancing numerous styles of dance.
□ Designing Dance Routines – Learn how to design easy to complicated dance routines of your own that reflect your individual style.
□ Tableau – Create “frozen pictures”, full of energy and emotion! Learn to tell a whole story in stillness and silence.
□ Readers’ Theatre - Do you love drama, but have problems memorizing your lines? This is for you! You get to perform with the script right in front of you! Scripts – Use a variety of script styles (humourous, thoughtful, inspirational) and learn to interpret and memorize your lines.
□ Improvisation – Have fun thinking on your feet while developing character and plot.
□ Scene Painting – Scene painting uses a variety of techniques to create illusions on stage to allow the audience to believe that items on the stage are real and to create specific atmospheres and moods.
□ Stage Make-up/Mask-Making – This is a two-part program in which campers will learn to make specific masks to be used for a chosen drama presentation, along with learning to use stage make-up to produce a variety of looks to greatly change and enhance actor’s presentations.
□ The Art of Story Telling (Grades 7-10) – Learn how to engage your audience; how to pull them into your story through the use of vocal dynamics; how to use gestures to heighten the tension, and how to keep them wanting more.
MUSIC OPTIONS
□ Vocal Production – Discover and compare the gift of the speaking and singing voice through combinations of ensemble and optional solo singing. Participants will present their experiences through an ensemble performance at the end of the week.
□ Exploring Group Composition Writing – Learn to compose a melody and lyrics in a group environment using various styles and techniques to create an original composition.
□ Exploring Rhythms in Sound – Through use of natural and found objects, select rhythm and percussion instruments, “Boom-Whackers”, noise-makers, and more, you will discover the world of rhythm in sounds.
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PLEASE RETURN THIS FORM WITH PAYMENT TO:ADULLAM CAMPS24 ELGIN STREET EASTCONESTOGO, ON N0B 1N0
WWW.ADULLAM.CA
HEALTH FORM
Camper Name
Address Postal Code
IN CASE OF ILLNESS OR ACCIDENT, PLEASE CONTACT Name Phone
Relationship Alt. Phone
Name Phone
Relationship Alt. Phone
Health Card Number H.C.Version Code
Birthdate
Gender M / F
Date of Last Tetanus Booster
Doctor’s Name Phone Number
Allergies (medication, foods, environmental)
Health or other information of which we should be aware
MEDICATIONS REQUIRED AT CAMP:
All medications must be in the original container with instructions and name clearly indicated.
By signing this form, the parent/guardian issues to the director and staff of Adullam Camp Ministries consent to the following:
1. In the event that an emergency arises, every effort will be made to contact me. However, if I cannot be reached, I authorize the director or staff to refer the camper to medical authorities on my behalf and authorize the medical authorities to provide diagnosis and treatment.
2. I authorize the director or designated first aid staff to administer medications that I have sent for the camper during his/her stay.
Signature of Parent / Guardian: Date:
I understand that I am expected to participate in the camp program as presented by thedirector and staff and promise to abide by the camp rules.
Signature of Camper: Date:
