Ketchen Lake Bible Camp

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					Ketchen Lake Bible Camp                                                                                              Registration Fees
Printer Friendly Registration Form 2010         * Ketchen Lake Bible Camp reserves
                                                the right to use any pictures taken at                               Fees             By May     After May
Name: _______________________________           Camp for promotional purposes.                                                        31/10      31/10
Address: _____________________________                                                                               Single           $125.00    $145.00
City/Town: ___________________________          Important Note to Parents:                                           Family           $345.00    $395.00
Prov.________ Postal Code: ____________         We endeavour to keep our fees as low as                              Rocketry ($10)
                                                possible. Canada Customs and Excise has                              Swimming
Phone: (____)____________
                                                put out an income tax bulletin (IT-495R2_                            Lessons ($25)
Birth Date: ________________
                                                that allows you to claim up to $150.00 for a                         Canteen         Included    Included
Age: _________       M/F                        child under 7 and up to $90.00 for children                          TOTAL
                                                7-14. All camp fees are legitimate childcare                         Cheque Enclosed
Parent/Guardian                                 expenses for all parents. We will issue you a
#1:___________________________________          receipt for your camp fees that will enable
Phone: (H)___________(W)_____________           you to take advantage of this tax                                    □  If you would like to send you child to
Cell:_________________                          deduction.                                                           camp but need financial assistance, please
                                                                                                                     check this box and mail in form as usual.
Parent/Guardian                                 Pick 3 activities in                                                 □   Please check if you DO NOT want any

#2:____________________                         order of                                                             further correspondence from KLBC or its

                                                                               Junior Teen
Phone: (H)___________(W)_____________           preference (1-2-3)                                                   associated churches.
Cell:_________________                          and an alternate

                                                                                                                     Medical Record and Waivers
Home Church:________________________
                                                Archery                                                              Name:_______________________________
This is my _______ year at KLBC.                Canoeing                                                             Sask. Health Card #___________________
                                                Riflery (pellet guns)                                       NA       Alternate contact if parents cannot be
                                                Training Cabin                 NA            NA             NA       reached:
Cabin Mate request (only one
                                                Leaders                                                              Name: ___________________Ph:_________
                                                Crafts                                                               Doctor:__________________ Ph:_________
                                                Drama                                        NA             NA
_____Teen _____Jr. Teen                         Nature                  NA     NA            NA
_____Intermediate _____ Junior                                                                                       Any reason to restrict camper’s
                                                Rocketry – Extra                                            NA
                                                                                                                     activities at camp? Yes/No
Registration Notes:                             Sports                                                               Explain:
- Send all forms in together when registering   Swimming Lessons                                                     __________________________________
for the family rate.                            * $25.00
- Family rate doesn’t include campers           Trampoline              NA                                           Has camper been under medical care
attending more than one camp per year                                                                                in the past two months? Yes/No
                                                Wilderness Survival                                         NA
- No refunds after June 15th                                                                                         Explain: ______________________________
- If unable to afford the full fee, please
contact one of the sponsor churches or          * If you plan to take swimming lessons,
Carol Steppan. Financial assistance may be                                                                           Is camper on prescription medication?
                                                please list last level completed_______.
available.                                                                                                           Yes/No

If camper is subject to any of the
following, please circle and explain on
a separate page:
Bedwetting, sleepwalking, fainting,
bronchitis, skin disease, diabetes,
convulsions, epilepsy, hay fever,
frequent colds, kidney trouble, ear
trouble, asthma, headaches,
nightmares, hysteria, other.
If camper is allergic to any of the
following, please circle and explain on
a separate page:
Food, drugs, penicillin, hay, straw,
insect bites, other

Additional information on separate
sheet? Yes/No

I/We hereby:
a) authorize the Camp Medical Staff
and/or Director to obtain such medical
advice and services as my be deemed
necessary for the health. Safety of my
child/our child and will reimburse the
Camp for any expenses incurred.
b) Agree to not hold the Ketchen Lake
Bible Camp, its Board of Directors,
officers, employees, agents or
volunteers viable for any of the above
on behalf of myself/ourselves and on
behalf of my/our child.

Signed this _____ day of _________ 2010.

_________________     _________________
  Parent/Guardian      Parent/Guardian

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