RKY Camp – Ontario, Canada

SCHEDULE

FORMS

ONLINE 2010
SUMMER CAMP REGISTRATION

ONLINE 2010
WINTER CAMP REGISTRATION

WINTER 2010 REGISTRATION FORM

IMPORTANT:

Please use one form per person.

You have 2 ways to register:

Fill our out Online Registration form below,
or Download our Registration form here.

Step 1: Choose one session only.

Please fill out one form per participant or family. If you are registering for Women’s Weekend please fill out one form per participant.

Sessions:

P.A. Day Camp - February 1, 2010

March Break Camp - March 15-19, 2010

Family Camp Weekend - June 11-13,2010 (all ages)

Women's Weekend Camp - September 17-19, 2010 (Must be 19 yrs of age)

Step 2: Camper(s) Contact Information - Please fill out in full

Camper #1 First Name:

Camper #1 Last Name:

Camper #1 Birth Date:

DD/MM/YY

Camper #1 is an:

	Adult (18+)
	Youth (8-17 yrs.)
	Child (3-7 yrs.)
	Under 3 yrs.

Camper #2 First Name:

Camper #2 Last Name:

Camper #2 Birth Date:

DD/MM/YY

Camper #2 is an:

	Adult (18+)
	Youth (8-17 yrs.)
	Child (3-7 yrs.)
	Under 3 yrs.

Camper #3 First Name:

Camper #3 Last Name:

Camper #3 Birth Date:

DD/MM/YY

Camper #3 is an:

	Adult (18+)
	Youth (8-17 yrs.)
	Child (3-7 yrs.)
	Under 3 yrs.

Camper #4 First Name:

Camper #4 Last Name:

Camper #4 Birth Date:

DD/MM/YY

Camper #4 is an:

	Adult (18+)
	Youth (8-17 yrs.)
	Child (3-7 yrs.)
	Under 3 yrs.

Street Address 1:

Street Address 2:

City:

Province:

Postal Code:

Home Phone:

Work Phone:

Family or Parent Email:

Emergency Contact Name:

Emergency Contact Phone.:

Relationship (to camper):

Dietary and/or Health Concerns?

please do not bring nonprescription drugs or vitamins to camp

Step 3: Camper(s) Requests

* Requests are honoured on a first-come, first-served basis. If a request cannot
be honoured, you will be contacted to discuss an alternative option.

Cabinmate Request:
Cabin Preference:
Cabin Neighbour:

Step 4: Fees and Payments

Please make payment in full to reserve your spot in desired program.
All camp fees are subject to 5% G.S.T. and 3% P.S.T. *
Programs offered are subject to change with the implementation of HST (13%) on July 1st, 2010. Any changes will be determined by information received from the government of Ontario.

P.A. Day Camp
February 1, 2010

x camper $30

March Break Camp
March 15-19, 2010

Check Box if you would like to participate in the March Break Camp. More details will be sent to you by email or by mail.

Family Camp Weekend
June 11-13,2010 (all ages)

x Adult (18+) $110

x Youth (8-17 yrs.) $110

x Children (3-7 yrs.) $60

x Under 3 yrs. FREE

Women's Weekend - September 17-19, 2010
(19+ yrs.)

x Adult Woman (19 yrs.) $140

I would like to make a donation to help SEND A KID TO CAMP!

Yes

RKY Camp is a registered charity. We provide over $40,000 each year to help send kids to camp. Please consider making RKY Camp your charity of choice. All donations over $10 will be receipted for tax purposes.
(Charitable Registration # 119121341RR0001)

If yes, please enter the donation amount:

$10

$25

$50

$100

Other amount:

Please deduct the following donation amount from my credit card:

Once

each month, beginning on the this date:

Payment Method:

Cash

Cheque

VISA

Mastercard

Other Payment:

Credit Card number:

Expiry Date:

Name on Card:

By clicking on the Submit button, I confirm that I have authorized to make payments and that I have read the Terms below.

Waiver of Liability

The individual(s) noted above is/are hereby permitted to attend the identified program/camp noted on this form and operated by RKY Camp. n signing this document, I hereby provide permission for the individual(s) noted above to participate in a full range of activities, unless I notify you otherwise in writing. authorize the Camp Director, or his/her designate, in the event of accident or illness affecting any of the individuals noted above, to approve all procedures and related expenses, including admission to hospital, surgery, aesthesia, injections, or any other necessary treatment therein, as deemed essential for the care and well-being of such individual(s) in my care. uch action is to be taken only when immediate contact with the undersigned cannot be made. agree that, having taken such precautions as in your discretion are deemed advisable, RKY Camp shall not be held responsible for any accident or sickness affecting the individual(s) identified above, or for any loss or damage to his/her/their property. I understand that, should any of the individual(s) identified above, in the judgment of the Camp Director, become a hazard to his/her/themselves or to others at the program, then such individual(s) may be sent home from the program without refund. Iunderstand that pictures/videos taken at the program may be used for promotional purposes.

I have read and understand the payment plans and refund policy applicable to this program/camp. To the best of my knowledge, the individual(s) identified above is/are in good health. I agree to inform RKY Camp of any infectious diseases, which any individual(s) identified above may have been exposed to during the three weeks prior to arriving at this program/camp.

I also affirm that I am legally responsible for any child/minor identified above and have legal binding authority to commit to the terms of this waiver on his/her/their behalf.

Cancellation and Refund Policy

RKY Camp reserves the right to cancel any programs if a minimum number of participants have not registered one week before the program is to run. RKY Camp will issue full refunds if this occurs.
Participants must cancel a minimum of two weeks prior to the program in order to receive a full refund.
No refunds will be given after this time, unless for exceptional reasons only (medical, or emergency family situation).
A $25.00 service charge will be levied on NSF cheques.
Refunds are not granted if participant withdraws from the program early, or if asked to leave due to misconduct.