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. (Cost is for the week)

Cabin - $100

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

Trailer Site (no power) - Free

Tent Site - Free

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)

E-Transfer (accounting@redberrybiblecamp.com)

Date *

Date

YYYY

Family Camp Payment

Family Camp Registration

Family Camp Registration Form

Redberry Bible Camp

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