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Hiddenbay.ca2014 OVERNIGHT CAMPER APPLICATION FORM
Please return to: 15203 Yonge St., Aurora, ON, L4G 1L8 Tel: (905) 841-1314 or (416) 969-8133 Fax: (905) 841-8889 Email: email@example.com www.hiddenbay.ca Please circle Busing Options for all camp sessions Name (first):_______________(last)________________ To Camp: Aurora Barrie Parry Sound Other
Date of Birth: ____________Age: _____Sex: M / F From Camp: Aurora Barrie Parry Sound Other
School: ______________________ Grade: _____ Camper’s Health Card Number: _____________________ 2014 Camp Sessions (All fees include busing)
5 Day Sessions ($500) +HST
Name (first & last): ______________________________ 7 Day Sessions ($700) + HST
Street: ______________________________________ Postal Code:___________ Country: ___________ 12 Day Session ($1080) +HST
Email Address: ________________________________ Home Telephone: _______________________________ Business: __________________ Cell:_______________ Leadership Sessions
Sun. July 27 – Sat. Aug 9 ($1400) + HST* Parent/Guardian 2
*additional fee if certification in ORCA, Royal Name (first & last): ______________________________ Street: ______________________________________ Mon. June 30 – Fri. July 25 ($2000) + HST* *additional fee if certification in ORCA, Royal Postal Code:___________ Country: ___________ Email Address: ________________________________ Please make all cheques payable to YPCE and
include applicable taxes and return with your
Home Telephone: _______________________________ application form. Above prices do not include
Business: __________________ Cell:_______________ I would like to pay my deposit of $150.00 by Parent/Guardian with Custody
I would like to pay all remaining fees on April 30, 2014 Both Parent 1 Parent 2 Other ______________ Emergency Contact
Credit Card Number _____________________
Name (first & last): ________________________ Expiry Date: _____/ _______
Telephone: ______________________________ Name on card: _________________________
Relationship of Emergency Contact: _____________ Signature: ____________________________
Received on: ______________ Payment Amount: $___________ volunteering during your camper’s stay. Health F Attached Immn F Attached 2014 OVERNIGHT CAMPER APPLICATION FORM
Please return to: 15203 Yonge St., Aurora, ON, L4G 1L8 Tel: (905) 841-1314 or (416) 969-8133 Fax: (905) 841-8889 Email: firstname.lastname@example.org www.hiddenbay.ca
Income Tax Receipts
Tax receipts for enrolment fees paid will be issued in February of
the following year. Please inform the office of any address This will be the applicant’s ______ year(s) at Hidden Bay NSF Payments/Cheques
A $50.00 service charge will be levied on all NSF payments. ____________________________________________ Replacement cheques must include the service charge and must _________________________________________________ Cancellation & Refund Policy
If possible, my child would like to be in a cabin with (in Hidden Bay Leadership Camp reserves the right to cancel any camp session if a minimum number of participants have not 1) ________________________________________ registered one week prior to the program starting. Hidden Bay 2) ________________________________________ Leadership Camp will issue full refunds if this occurs. Refunds are not granted if the parent/guardian withdraws a Please note that cabin groups are determined by length of camper before the end of the session, if the camper arrives with a stay at camp (Ex. 5 day session campers together, 7 day communicable disease or is sent home for misconduct. session campers together). All requests must be received by Fees are refundable, less the non refundable deposit ($150.00) up June 1, 2014. Unfortunately we are unable to guarantee to April 30, 2014. Thereafter, they are refundable only for medical reasons with a doctor’s certificate prior to the beginning
of the child’s session at camp. Any requests for refunds must
be made in writing to the Camp Director prior to the start of
If you would like us to send Camp information to friends or the session.
family, please list their names and addresses: Hidden Bay Leadership Camp will not be responsible for any loss or theft of the camper’s property. My camper will participate in the full camp program unless the camp is provided with medical information regarding specific Authorization
I hereby waive, release and absolve and agree to indemnify and save harmless Hidden Bay Leadership Camp and York Professional Care & Education Inc., its trustees, directors, corporations members, staff and agents of and from any and all liability arising there from, except such as shall arise solely as a consequence of its or their wilful negligence or wilful default. Terms and Conditions
If for any reason my child requires medical attention or special medication beyond that furnished by the camp, I agree to be Enrolment is subject to the following conditions: responsible for any expenses incurred. I give the Camp Camp Space
Director/Designate permission to transport my child to a nearby Age, grade and gender are considered when determining physician or hospital, and to obtain medical attention necessary available space in the session(s) of your choice. for my child’s welfare and good health including ordering injections, anesthesia or surgery. In such situation, the camp will After Registration
attempt to notify the parents as soon as possible. Each camper Upon receipt of the completed Application/Health History forms and payment, a confirmation letter will be sent to confirm your registration. I consent to Hidden Bay using any photos/videos taken of my child in its promotional materials and website. Refusal & Dismissal
I have read, understand and agree to the Terms and Conditions. Hidden Bay Leadership Camp reserves the right to refuse a camper based on previous camp behavior, misconduct or a lack of resources to meet a child’s medical needs. A full refund less deposit will follow should this occur. The camp admin has the right to dismiss any camper who in their opinion is a hazard to the safety or rights of others, who appears _________________________________________________ to have rejected the reasonable expectations of camp, or who arrives with a communicable disease. I am responsible to
provide their return transportation.
2014 CAMPER HEALTH FORM
Mail this form by April 30, 2014 to Hidden Bay Leadership Camp or Fax: (905) 841.8889 or e-mail to email@example.com
Date of Birth (month/day/year) Age: as of July 1, 2014 Physician’s Name: ______________________________ Phone Number: _____________________________ Physician’s Address: _____________________________________________________________________ Does your child carry an Epi pen? Yes No If yes what do they carry the Epi pen for? _______________________________________________________ Does your child wear a medic-alert bracelet? Yes No
If yes what do they wear the bracelet for? _______________________________________________________
I understand that should my child require either Ana-Kits or EpiPens, Ventolin or other specific medication
related to the allergy, I will provide the required medication.
Please list any allergies, food conditions, health, behavioural or medical conditions your child has:
Please note: all medication (prescriptions and over the counter medications) must be in the original package and
labelled with your child’s name, accompanied by a signed note from the parents/guardian giving permission for the
medication to be administered to your child according to the package instructions. Your child will NOT receive their
Medications accompanying my child to camp:
1._____________________________________________ 3. ________________________________________
2. _____________________________________________ 4. ________________________________________
See Parent Handbook regarding all Health Questions.
It is mandatory that a copy of your child’s immunization card is submitted with this form.
Please note: Your child will be expected to eat the nutritious meals provided unless an allergy is identified with
a Doctor’s note
Hidden Bay Leadership Camp is nut aware. This means we do not serve nut products, but are not responsible for food served that
may contain traces of nuts as indicated on the packaging. We ask that parents do not send food to camp. It is expected that all
children including those on any medication will still be able to participate fully in all the camps programs and activities.
My signature below indicates all information on this Health Form is complete and accurate.
Parent/Guardian: ______________________________________________ Date: ______________________
Estado do Rio Grande so SulPREFEITURA MUNICIPAL DE BROCHIERCompras (Art.2º, Inciso XXIV) Junho de 2011 Pag: 1------------------------------------------------------------------------------------------------------------------------------------Empenho Emissao Fornecedor CNPJ Processo Licit. Despesa Recurso V.Empenhado Item Qtde UN Especificacao Valor Unitario Valor Total01 CAMARA DE VEREADORES01.01