Pine Lake Christian Camp Registration

Name:                                               M       F               Entering Grade:                               

Date of birth:                          

Address:                                                                                                                                  

email:                                                                                                                                     .

Phone:                           City:                                         Province:                          PC:          

 Home Church:                                                        Pastor:                                          Phone                      

Alberta Health Care#:                                                              

 Medical/Diet Concerns:                                                                                                                                                              

                                                                                                                                                                                                    .

 Parent/Guardian:                                                          Contact Numbers:                                                

Alternate Contact Name:                                                Contact Numbers:                                                 

The signing of this registration form by the parent/guardian gives permission for the listed camper to attend Pine Lake Christian Camp for the period listed; to be giving emergency medical treatment if required: to ride as a passenger in camp vehicles; to be evacuated by air if necessary; and to participate in all camp activities as outlined in the camp literature. Any exceptions should be noted here:                                                                                                                        .

Pine Lake Christian Camp takes great pride in maintaining safe practices. All programs run under rigid safety guidelines and procedures.

Nonetheless, participants need to be aware that there is a risk inherent in any outdoor adventure program.

Our signatures below indicate a desire to participate in the Pine Lake Christian Camp program, and an understanding of its nature. The camper agrees to abide by the rules of the camp.

Signature of camper:                                                                       Date:                                              .

Signature of parent(s):                                                                     Date:                                              .

      or Guardian(s)                                                                           Date:                                              .

 Photo Release: if you are willing to allow Pine Lake Christian Camp to use photographs in which you or your child appear for appropriate promotional materials, please sign below

 Signature of parent or guardian                                                                  Date                                                   .

Camp:                                       Dates                                                                Fee: $                          

    Cheque       Visa       Master card

Register 2 weeks prior to start date of camp and recive $25 off registration of kids camps (except rookies where you recive $15 off)

Refund Policies:

1. If cancellation is made seven (7) days prior to start of camp, the full registration fee will be refunded.
2. If cancellation is made within seven (7) days of start of camp, the registration fee less 25 % will be refunded. If there are medical or emergency circumstances, the full amount will be refunded
3. No refund will be given for campers sent home for discipline reasons
4. No refunds will be given for late arrivals or early departure.
5. Withdrawal from camping on Doctor’s orders a refund for the number of days remaining in the camping week will be refunded to the camper.

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Credit card holder name (as it appears on card):                                                    

Signature:                                                                                               

Credit card #:                                                                        Expiry Date:         /         

MAIL TO: Pine Lake Christian Camp, Box 41 , Pine Lake, AB. T0M 1S0 (Cheques payable to Pine Lake Christian Camp)