Email Address
Parent's email address (we will send receipts and letters via this address) *
Confirm email address *
Camp Selection
Camper is... *
New to Camp Evergreen - Welcome!
Returning - Welcome Back!
Select the camp.
Grade the child is entering in September, 2010.
GST included in all prices.
Please note that all camps begin on SUNDAY , except for Sparks 1 & 2, Explorers 2, & PUSH 2. with registration from 3:30-4:30pm.
* An additional application form will be emailed to you for Trails Away or any of the AIM camps. That form must be submitted before your spot is confirmed.
Tuck is included in the camper fees for On Site and Roughin' It camps. Please do not send money with your child.
*
On Site Camps
Out Trip Camps
Adventures In Ministry (AIM) Camps
Skill Options for Trail Blazers, Ignite and Impact Only. Horsemanship has limited spaces so it cannot be a guaranteed choice.
Skill Option 1
- Select -
Adventure Programming Canoeing Climbing Engineering Handcrafts Horsemanship Marksmanship Mountain Biking (camper must supply Bike and Helmet) Sports Survival Skills
Skill Option 2
- Select -
Adventure Programming Canoeing Climbing Engineering Handcrafts Horsemanship Marksmanship Mountain Biking (camper must supply Bike and Helmet) Sports Survival Skills
Skill Option 3
- Select -
Adventure Programming Canoeing Climbing Engineering Handcrafts Horsemanship Marksmanship Mountain Biking (camper must supply Bike and Helmet) Sports Survival Skills
Camper Information
Last Name *
First Name *
Address *
City *
Province *
Postal Code *
(i.e. T3K 5H4)
Phone *
(i.e 403-123-4567)
Gender *
Male
Female
Date of Birth *
MM
01
02
03
04
05
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10
11
12
DD
01
02
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YYYY
1985
1986
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1991
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1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
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2008
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2010
Grade as of Sept. 10 *
Home Church (if applicable)
How did you first hear about Camp Evergreen? *
Family
Church
Another camper
Internet
School Trip
Other
Please let us know who referred you (if applicable)
Are you requesting a cabin mate? *
Yes
No
Name of cabin mate (only 1 please)
Emergency Contact Information
Parent/Guardian 1 *
Relationship to Camper
Phone *
(i.e 403-123-4567)
Work Phone
(i.e 403-123-4567)
Cell
(i.e 403-123-4567)
Parent/Guardian 2
Relationship to Camper
Phone
(i.e 403-123-4567)
Work Phone
(i.e 403-123-4567)
Cell
(i.e 403-123-4567)
Alternate Contact: (different from above) *
Relationship to Camper
Phone *
(i.e 403-123-4567)
Cell
(i.e 403-123-4567)
Medical Information
Provincial Health Care # *
(i.e. 12345-1234)
Medical Plan Co. & # (optional)
Family Physician
Phone Number
(i.e 403-123-4567)
Date of last tetanus shot (campers are expected to have had a tetanus shot in the last 10 years)
MM
01
02
03
04
05
06
07
08
09
10
11
12
YYYY
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Does your child have any special physical, emotional, behavioural, learning or social needs we should be aware of? (ADD/ADHD, Diabetes, Vision Impairments, Bed Wetting, Headaches, Cramps, Ingestions, Depression, etc) *
Yes
No
If Yes, please explain
Any allergies? *
Yes
No
If Yes, please specify the allergy, & usual reaction
Any dietary concerns? *
Yes
No
If Yes, please explain
What medication will your child be bringing to camp? *
Any medication UNSAFE for your child? *
Any other information about your child that you think we should know?
Payment Information
Fees are to be paid in full at the time of registration to secure your camp enrolment. Refunds will be issued up to 30 days before your camp commences, less a $100 cancellation penalty.
Additional Fees/Discounts
Early Bird Special - Pay by March 1, 2010 ($10 discount)
Family Discount - 1st child pays regular rate, subsequent children receive $10 discount
Camp T-shirt (additional $15)
Memory DVD (additional $10)
Please note that Memory DVDs are only available for on site and AIM camps.
Are you requesting Campership Aid? (If yes, we will send you an application form for Campership Aid) *
Yes
No
Would You Like to Make a Tax-Deductible Donation to Camp Evergreen?
Yes
No
Camp Evergreen is a registered not-for-profit organization and we rely on the generous support of donors to keep our camp fees
as low as possible.
Payment Method *
Credit Card (visa/mastercard/amex)
If you're paying by credit card, don't forget to call the camp office at
403-638-4230 after submitting this form to provide your credit card information. Your child's
registration cannot be processed without it!
Cheque