Family Camp Registration Form

Parent/Guardian #1 Name *

Parent/Guardian #1 Name

First Name

Last Name

Parent/Guardian #2 Name

First Name

Last Name

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone *

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Email *

Children

Child #1 *

Child #1

First Name

Last Name

Age

Child #2

First Name

Last Name

Age

Child #3

First Name

Last Name

Age

Child #4

First Name

Last Name

Age

Child #5

First Name

Last Name

Age

Child #6

First Name

Last Name

Age

Emergency Contact Information

Name *

Name

First Name

Last Name

Relationship to Applicants *

Home Phone *

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Health Record

For each member of the family please provide their name, health #, family doctor, clinic and clinic phone number.

Family Member #1

First Name

Last Name

Saskatchewan Personal Health #

Family Doctor

Clinic

Clinic Phone Number

(###)

###

####

Allergies/Health Concerns

Family Member #2

First Name

Last Name

Saskatchewan Personal Health #

Family Doctor

Clinic

Clinic Phone Number

(###)

###

####

Allergies/Health Concerns

Family Member #3

First Name

Last Name

Saskatchewan Personal Health #

Family Doctor

Clinic

Clinic Phone Number

(###)

###

####

Allergies/Health Concerns

Family Member #4

First Name

Last Name

Saskatchewan Personal Health #

Family Doctor

Clinic

Clinic Phone Number

(###)

###

####

Allergies/Health Concerns

Family Member #5

First Name

Last Name

Saskatchewan Personal Health #

Family Doctor

Clinic

Clinic Phone Number

(###)

###

####

Allergies/Health Concerns

Family Member #6

First Name

Last Name

Saskatchewan Personal Health #

Family Doctor

Clinic

Clinic Phone Number

(###)

###

####

Allergies/Health Concerns

Family Member #7

First Name

Last Name

Saskatchewan Personal Health #

Family Doctor

Clinic

Clinic Phone Number

(###)

###

####

Allergies/Health Concerns

Does anyone in your family have diet restrictions? Please provide any information below:

Prices Per Person

Adults (age 17+) - $149.00 each /\ First 2 Children (ages 5-16) - $124.00 each /\ 3rd+ Children (ages 5-16) - $62 each /\ Children (ages 0-4) - Free

The first 2 children (ages 5-16) are full price. Each Child after that (ages 5-16) will be half price. Example: 2 Adults & 4 Children = 149+149+124+124+62+62

Accommodations

Please select from the available accommodations. Options will change according to availability. The number in brackets is the amount of beds in that cabin. (Cost is for the week)

Sandpiper Lodge - $100

Redstart Rest - $80

Trailer Site (20 amp 110 volt power) - $20

Trailer Site (no power) - Free

Tent Site - Free

Are you are willing to share accommodations with another family and split the cost?

Write the name of the family you would be willing to share with

Please choose one of the forms of payment. *

A $50 deposit is required to hold your family's spot in camp.

Cheque (mail in)

Credit Card (phone in - 306-477-4410)

Date *

Date

YYYY

Family Camp Payment

Family Camp Registration

Family Camp Registration Form

Redberry Bible Camp

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