2010 Summer Camp Online Registration

For detailed information please consult the Registration information before filling out this form. 

The full amount of your registration will be charged to your credit card immediately upon submitting the registration.

(* Required)
Camper Session
Session *	Please Select Youth Week Explorer Camp Ultimate Junior Varsity* Choose Elective Below Junior Varsity Extreme Oasis Day Camp * Select T-shirt size below
Oasis Day Camp T-shirt Size	Please Select Child’s S Child’s M Child’s L Women’s S Women’s M Women’s L Women’s XL Men’s S Men’s M Men’s L Men’s XL
Ultimate Junior Varsity Only
Please indicate which electives you would like to participate in. You may choose either Basketball OR Soccer OR 2 of the electives from the group listed below.
Basketball - OR - Soccer
OR Choose 2 of the following: (Electives are on a first come first serve basis)
Outdoor Adventures (climbing wall, off-site activities, low ropes initiative) Swimming Lessons (Red Cross Level 1-10)          Please indicate which swimming level: Craft Guitar Lessons (Beginners) - rental guitars available          Please check box here if you need a guitar:
Camper Information
First name *
Last Name *
Mailing Address *
Mailing Address 2
City *
Province/State *
Postal Code *
Country
Telephone *
Camper E-mail *
Gender *	Please Select Male Female
Birthdate * as of December 31, 2010 (MM/DD/YY)
Age *
Health Card Number *
Church Name
Cabin Mate Requests Great effort is made to honour mutual requests for cabin mates of similar age/grade. Check with the other family before making the request; we do not give out information regarding campers.
Parent/Guardian Information
Camper lives with *	Please Select Both Parents Father Mother Guardian
Father Name
Father Phone
Father Cell
Father business Phone
Father Email
Mother Name
Mother Phone
Mother Business Phone
Mother Cell
Mother Email
Guardian Name
Guardian Phone
Guardian Cell
Guardian Email
Camper Medical Information
Severe Allergies *	Please Select Yes No
Regular Medication *	Please Select Yes No
Physical, emotional or behavioural problems *	Please Select Yes No
If you answered “yes” to any of these situations, please write a full explanation so appropriate preparations can be made.
Emergency Contact
Name *
Relationship of Camper *
Phone *
Consent
I have read this form thoroughly and to the best of my knowledge the information is correct. I hereby consent to give the camp director, in case of emergency, the right to take my child as warranted, to the facility as warranted, in the best interests of the camper. Before emergency treatment at a hospital is given, every effort will be made to contact the parent/guardian. While every precaution shall be taken to ensure the welfare and protection of the camper, Guelph Bible Conference Centre, its Directors and staff are hereby released from any liability in the event of accident or misfortune that may occur to the camper. I hereby give consent for my child to be transported off the Guelph Bible Conference Centre property for Field Trips and Special Events related to camp activities. I am aware that Guelph Bible Conference Centre may use my child's photo in promotional literature and/or website. To the best of my knowledge, my child is in good health. I will notify the camp by written document if my child is exposed to an infectious disease or there is a change in health during the weeks prior to arriving at camp.
I Agree *
Assist Others
Would you care to contribute to our sponsorship fund to assist another child or family attend summer camp? If yes, please enter amount!
Yes/No:	No Yes
Assist Other Amount:
Credit Card Information
Name on Card:	*
Card Type:	Please Select Visa MasterCard *
Card Number:	*
Expiration Date:	Select Month 01 02 03 04 05 06 07 08 09 10 11 12 Select Year 2010 2011 2012 2013 2014 2015 2016 *
Security CVV (back of card):	*
Add: Tuck Deposit Amount:	($12.00 Recommended) Not for Oasis