Outdoor Family Fun!

Strengthening Family

Connections, Friendships

and Memories.

SASAMAT OUTDOOR

CENTRE

3302 Senkler Road, BC Belcarra, BC V3H 4S3

Program Starts: 6:30pm

Friday May 30th

Program Ends: 3:00pm

Sunday June 1st

Family Camp Weekend May 30th to June 1st, 2014

For more information contact Brigette, Family Camp Worker at

brigettebouchard@shaw.ca or call 604-736-3588

To Register visit the Kits House Office at 3683 West 4th Ave

Monday-Friday 9am-5pm. Cash or Cheque only.

Register early, space is limited!

www.kitshouse.org

REGISTRATION PACKAGE

INFO SHEET: Family Camp Weekend 2014

Cost of Family Camp: Fees

Adults (19 years+) $115.00

Youth (13-18 yrs) $ 95.00

Children (5-12 yrs) $ 85.00

Toddler (1-4 yrs) $ 75.00

Infants (0-12 months) Free

Family Membership Fee $ 20.00

Empty Bed Charge $ 50.00

Transportation (Kits House Van) $ 12.00 / person ($6.00 each way)

* Note: Actual cost for camp is $115 per person (for anyone over 1 year of age)

Things you need to bring:

Sleeping bag or warm blankets & a pillow

Toothbrush, tooth paste and toiletries

Flashlight

Books, board games, etc. (for time fillers & entertainment)

Clothes for 2.5 days (Sweaters, long pants, runners - one pair for walking &

one pair you don’t mind getting wet)

Rain gear (jacket & pants if possible)

Swim suit & towel (optional)

Things you should know:

Prices include: meals, accommodations, & activities

All meals will be provided: Friday light snack, Saturday breakfast, lunch &

dinner and Sunday breakfast & lunch

All participants will be asked to sign-up for a Volunteer Task

There is a $50 charge for empty beds - if you require your own cabin

All belongings should be labeled & put into a sturdy bag

Non-prescription drugs, alcohol & pets are not permitted on site

If you are providing your own transportation to Sasamat Outdoor Centre,

please arrive after 6:30 p.m. on Friday May 30th, 2014

Parking space at Sasamat Outdoor Centre is limited, so please try to carpool

Kits House Van Transportation:

Families that are registered to travel in the Kits House Van need to arrive with their luggage no later than 4p.m. on Friday May 30th, 2014

**Registration for Family Camp Weekend is on a first come first served basis**

DIRECTIONS TO SASAMAT OUTDOOR

RECREATION CENTRE How to get here

From the corner of St. John's Street and Ioco Road in Port Moody, turn North

onto Ioco Road. Turn left at the third traffic light and follow the signs to Belcarra

Regional Park. Turn right onto 1st Ave. which becomes Bedwell Bay Road. Drive

past the turnoff to White Pine Beach. Turn right at the stop sign, towards the

Village of Belcarra. Finally, turn right onto Senkler Road, the first road to your

right after entering the Village of Belcarra, and follow the wooded driveway into

Sasamat Outdoor Centre.

Translink Belcarra/Port Moody - #C26 If you are taking the Translink Shuttle

Link: http://sasamat.org/directions.html

Sasamat Outdoor Centre Camp Site Map

Registration Form

Full Name of Participants: Fee Amount:

Adult: __________________________________________________ ________________

Adult: __________________________________________________ ________________

Child: ______________________________________age: ________ ________________

Child: ______________________________________age: ________ ________________

Child: ______________________________________age: ________ ________________

Child: ______________________________________age: ________ ________________

KNH Van Transportation: (# of participants _____ x $12): ________________

KNH Family Membership ($20): ________________

Contact Information: Total Fees: ________________

Address: _______________________________________ City: ________________________

Postal Code: _________________ Phone #: _____________________________

E-mail: ___________________________________ Cell #: _____________________________

Questions:

1.Accommodation Preference—COTTAGE (4) / CABIN (6) ?

2.Diet Restrictions—please specify any allergies we should be aware of:

_______________________________________________________________________________

3.Car Pooling—are you able to drive another family? Y / N If yes, how many: _____

Registration Form

Waiver / Release Form

Medical Form

Amount Paid:_______

Receipt #:__________

Membership #:______

KNH Van Registration

Subsidy Form

KNH E-Newsletter

For Office Use Only: (check all information that applies)

Waiver / Release Form

I / we agree that members of our family will follow all reasonable instructions and directions of the

leaders and instructors duly appointed by the Association of Neighbourhood Houses (ANH) in

connection with the operation of the Family Camp Weekend on May 30th to June 1st, 2014.

I / we hereby release, and forever discharge ANH and its agents or volunteers, of and from all

manner of action, cause of actions, claims and demands of whatever nature which result from any

accidental injury, loss or expense sustained, arising out of in any way connected with participation

in any program, or attendance at any location operated by ANH.

In the event that my child is injured, ill or in need of medical attention and I am unable to be

contacted, I authorize KNH staff to seek medical attention on my behalf.

I / we authorize or do not authorize [circle one] Kitsilano Neighbourhood House (KNH) to use

and publish testimonials, feedback, photographs and video taken of me / family / child(ren) while

participating at Family Camp, for use in promotional materials, including but not limited to: posters,

website, social media, and advertising. This waiver release includes the right to modify and

retouch the above in the tasteful discretion of Kits House staff. I understand that there will be no

compensation to me for this use.

PRIVACY STATEMENT

Kitsilano Neighbourhood House and the Association of Neighbourhood Houses

respect your family’s privacy. The information collected on this form is in compliance with the BC

Personal Information Protection Act and is used to process program registration, help ensure the

safety and well being of members and to provide you and your family with information on events

and programs at Kitsilano Neighbourhood House. If you have any questions or would like a copy

of the ANH Privacy Policy please contact our office at 604-736-3588.

Kitsilano Neighbourhood House reserves the right to cancel a program

if there is low attendance or registration. A full refund will be issued for any

program cancelled.

___________________________________________

Name of Parent / Guardian (please print)

___________________________________________ _________________

Signature of Parent / Guardian Date

Medical Form **A Medical Form is needed for every family member**

Medical Form **A Medical Form is needed for every family member**

Medical Form **A Medical Form is needed for every family member**

Medical Form **A Medical Form is needed for every family member**