Registration Form 09 by 2J2xe89X


									                                                              2009 Manitoulin Youth Camp Registration
                                                                                                                          We are aware and sensitive to the concerns that have arisen as a result of the
                                                                         and Consent Form                                 unity situation in the Province and the impact it is having on inter-ecclesial
                                                                 (Includes consent for Emergency Medical Treatment        activities. As a Youth Camp committee we believe it is in the children’s best
                                                                       for Christadelphian Sunday School students         spiritual interest for us to move forward with plans for Youth Camp 2009, by
                                                                             between ages 9 and 16)                       faith and Lord willing. It is our hope and prayer that there will be a resolution of
                                                                                                                          the issues that are currently facing our community in Southern Ontario. If a
                                                                        DATE: July 18-25, 2009                            resolution is not found we recognize this will impact many of the preparations
                                                                         SUBJECT: Nehemiah                                previously made. We will inform all counselors and parents, if necessary, of
                                                                    SPEAKER: Bro. Jamin Wigzell                           any changes to our plans.

                                                               CAMP FEES:
Parent/Guardian’s Name                                                  $70.00 per student ( $51 + Main Camp’s $19.00 user fee) or                                NEW: Homework books will be
                                                                        $150.00 family rate + $19.00 per child for user fee (best rate for 3                      distributed to registered students at
                                                                        or more)                                                                                  the Toronto Fraternal Gathering =
Street Address
                                                               Extra: – Bus Fee - $10 per student using bus (flat fee)                                            please register early.
                                                                                                                                                                  Late fee to cover mailing costs.
                                                               - $5 Late Fee for registrations after March 31st (fee waived if you will
                                                               print your own homework book, sent to you by email)
City                        Prov./State       Postal/Zip
                                                               (cheques should be made payable to: Manitoulin Youth Camp)
                                                               Send registration to:       Judy Macfarlane
                                                                                                                                                                  We have an updated dress code to further
                                                                                           748 Hiawatha Blvd.                                                     the spiritual environment in the camp.
Telephone                        Emergency Contact #
                                                                                           Ancaster, ON L9G 3A7                                                   Details are in program book.
                                                                                  (905) 648-1266                                                Please ensure your children have
                                                               Actual cost is $120 per student/ if able to include amount                                         sufficient clothing for 7 days.
Ecclesia         Email Address
                                                               higher than $70 we would appreciate the contribution.

                                                                                                         PLEASE LIST ANY MEDICAL CONDITIONS THE REGISTRANT MAY HAVE: (i.e. Allergies,
  Names of Campers:                                          Birthdate    Sex     Health Card
  Last,         First                         Email          Y/ M / D     M/F     Number                 ADD, asthma…) or any other difficulties such as: bed-wetting, learning disability, fear of the dark,
                                                                                  (required)             homesickness, not want to go to camp, etc… Without specifying these things the counselor and child
                                                                                                         concerned are very disadvantaged. We are not trained for special needs.
                                                                / /
                                                                / /
                                                                / /
                                                                / /

I/we give my/our consent to the camp nurse to authorize emergency medical treatment to be administered should the necessity arise. I/ we and my child/children are responsible for any
property damage that my child might inflict in the camp, and the committee is authorized to deal with any discipline issues which may arise.

                 SIGNED      _____________________________                               (parent/legal guardian)
        BUS FEE: Transportation to Camp from Ferry at South Baymouth and Return                                                               AFTERNOON ACTIVITIES                                         Select 6
        to South Baymouth Ferry by Bus on Manitoulin Island.                                                                      A - Ping Pong               B – Cross Stitch             C – Photography**
         **You-(parent/guardian) are responsible for your camper to/from South                                                    D - Aussie Games            E – Beading * new            F – Candle making
                                                                                                                                  G – Archery                 H – Fishing                  I – Ultimate Frisbee
        Baymouth including while on the ferry. We require notification of who is your
                                                                                                                                  J – Crafts                  K – Fun with Food            L – Card making
        child’s guardian on the Ferry. – it is a grave concern to the committee that                                              M – Baseball                N – Volleyball               O – Orienteering
        children be sufficiently supervised to/from the camp.                                                                     S – Basketball              T – Floor Hockey             U – Nature Sketching
                  Fee: $10 flat rate – non-refundable. Please indicate if you wish this                                           V – Astronomy               W- Watercolour Painting *new
        service and which adult is accompanying your children.                                                                    CANOEING: P = juniors/int.        Q = Teens/ adv techniq ues
                                                                                                                                  R - DRAMA will require a full week commitment, so if this is your primary
        For bus coming to camp, students must be on the Ferry that departs
                                                                                                                                  interest, please select RRRRRR – you will receive a copy of the play prior to
        Tobermory July 18, 2009 at 11:20 a.m.                                                                                     camp so you can come prepared.
        For bus taking students home from camp, students will be put on the Ferry                                                 We offer campers two 3-day activities for the week. Please pick 6 and
        that arrives Tobermory July 25, 2009 at 10:55 a.m.                                                                        hopefully we can fit from your favorite choices. Filled in order received!!!
                                                                                                                                  (** Please do not repeat this choice from previous years in order to allow others a chance to

                                         Shirt     Shirt Size   Request 1 camping buddy                   PM Activity – Select                    Camp             Bus Fee ($10 flat fee) + GUARDIAN NAME                         Total
                                         Size      Please       Camp is a great time to make new
                                                                                                          1st/ 2nd / 3rd/ 4th /5th /6th           Fee              on ferry
           Camper’s Name                 Please    circle       friends! You are more likely to get the
                                         circle                 ‘buddy’ you request if it is someone
                                         Adult/                 outside of your geographic
                                         Youth                  area..
                                         A/Y         S/ M/ L                                                 /     /     /    /       /           $70              $10 to     _________from  _______________
                                         A/Y         S/ M/ L                                                 /     /     /    /       /           $70              $10 to     __________from  ______________
                                         A/Y         S/ M/ L                                                 /     /     /    /       /           $family          $10 to     __________from  ______________
                                         A/Y         S/ M/ L                                                 /     /     /    /       /           $family          $10 to     __________from  ______________
                                                                Family Rate                                                                       $150             LATE FEE After March 31st
 If you counseled in 2008 and intend to                         ___ students X $19 user fee                                                       $                $5 x ____ students
 counsel this year, please include squirt fee in
                                                                ___ students X $10 Bus                                                            $                Or $0 if we email homework for you to print :
 total payment, if applicable: # squirts x $15
                                                                ___ squirts X $15 (see note in left column)                                       $ ____           Email: _______________
                                                                Family Rate TOTAL                                                                 $____

                                                                                                                                                                              Indicate if you (Christadelphian parent/ guardian)
     PLEASE NOTE: **NEW ** (For those students who will attend the New Family Camp the previous                                                                               would be interested in counseling.       Yes 
     week) Kids Camp officially starts at 12:00 noon on Saturday, July 18, and you need to have guardians                                                                     (You will be contacted, if needed)
                                                                                                                                                                              Please list name / birthdate of any squirts.
     for your children until then. Please list guardian: ___________________________________                                                                                  ________________________________________
      (For those students who would like to attend Main Camp the following week) MAIN CAMP WILL NOT                                                                           ______________________________
     BE ACCEPTING ANY STUDENTS WHO HAVE NOT PRE-REGISTERED TO STAY FOR                                                                                                        $15/squirt fee: If you counseled in 2008 and
                                                                                                                                                                              plan to counsel again, please include squirt fee in
     THEIR CAMP. Please register with Bro. Al Browning 416-284-0290 before camp.                                                                                              payment with registration form.

Total camp fee is due no later than May 15 th. The food is purchased in May and June for the Camp, as a result the food portion of your registration fee will be non-refundable after May 15.

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