2004 Camper Registration Form
Shared by: NikFozzar
2009 Camper Registration Form Early Bird Deadline: 5/1/09 Regular Deadline: 5/15/09 Registration Form may be submitted with $25 non-refundable deposit before deadline. After deadline, please call to check on available space. Please DO NOT send campers without registering. Name: Phone: Covenant Bible Camp Address: City: State: Zip: Unalakleet, Alaska Birth date: Grade Completed: Weight: Gender: M or F 907-373-2322 Email: _______________ Emergency contact: Phone: www.cyak.org/about/cbc.html Leadership Camp –grades 9-12 May 27-June 1 - $95 Early Bird, $120 Regular, For Office Use Only DR _____ Senior High –grades 9-12 June 1-8 - $120 Early Bird, $145 Regular * $25 fee for registrations AR _____ FOP ______ Junior High –grades 7-8 June 8-15 - $120 Early Bird, $145 Regular after the regular deadline, RG _____ TR _______ AD _____ SM _______ Trailblazers –grades 5-6 June 15-20 - $95 Early Bird, $120 Regular call to confirm if there is AR _____ FOP ______ RG _____ TR _______ Pathfinders –grades 3-4 June 20-25 - $95 Early Bird, $120 Regular space available. SM _____ AD _______ TRAVEL: If camper will travel to Unalakleet please complete the travel information in the box: BR ______ SM ________ NORTON SOUND REGION OTHER ALASKA REGIONS Please make your own arrangements with a I would like Covenant Bible Camp to make travel arrangements. Camper will commercial carrier—ask for Bible Camp travel on the dates chosen above unless other arrangements are approved. rates. Camper should travel on the dates Please enclose the following for roundtrip flights to Unalakleet: chosen above unless other arrangements are Y-K Delta and Kotzebue Regions $ approved. Camper will travel with: Anchorage/Soldotna $ Bering Air Hageland Aviation I will make travel arrangements on my own, with The last night of camp, the campers are brought to Unalakleet to prepare for travel. Please choose one of the following: In Unalakleet, camper has permission be released to at (phone #). I understand that this person will be responsible for camper and for getting camper to the airport to travel home. Camper will stay at the Covenant Youth Facility under the supervision of the camp staff and travel home the day camp ends. Medical problems? Allergies? Medications? No Yes—Please explain: I/We , the parents/guardians of (The minor child), and said minor child voluntarily release COVENANT BIBLE CAMP, THE EVANGELICAL COVENANT CHURCH OF ALASKA and REPRESENTATIVES thereof from any suit, damage, action or any other claim of any nature, as well as the hosting church and activity supervisors. In case of any emergency, I/we give permission to secure proper treatment for my child as needed. I consent to any x-ray exam, anesthetic, medical, or surgical diagnosis or treatment. I also understand the camp staff may discipline or send my child home without refund if he/she does not comply with camp rules. Date Parent/Guardian Signature Printed Name CAMPER PROMISE: I promise to obey all camp rules. I agree to stay on camp grounds during the camp session unless I have the permission of the Camp Director. I understand that I may be sent home for not obeying camp rules. Date Camper Signature (IF 18 or older you don’t need parent signature) Printed Name Please make check or money order payable to Covenant Bible Camp. Mail registration and fees to Registration: ________ Covenant Youth of Alaska 5201 Mayflower Lane Wasilla, AK 99654. Forms may be faxed to Travel (if applicable):________ 907-376-7729. A $25 deposit needs to be made by deadline to reserve spot. Space is limited! Deposit is NON-REFUNDABLE. Spending Money*: ________ If you would like to pay with your Credit Card please call 907-694-6348. For all other questions Donation: ________ please call 907-373-2322. After May 23rd call 907-624-5050. Family Discount— Pay full price for the oldest child, and receive 25% off registration for Total Enclosed: ________ others in the same household. Send forms together and by the deadline to receive discount. *Spending money is held on account for camper for canteen and offerings. $25 or less.