Registration Forms

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Malagash Bible Camp
Registration Forms


Register for camp by printing off the following forms and sending them to the address at the bottom of this page.

2004 YOUTH CAMP REGISTRATION Please use a separate form for each Camper Campers Full Name: ________________________ Date of Birth (mm/dd/yy) / / Address: __________________Rural St #__________ Grade in Sep. 2004: ___ City/Town: ___________________________ Male /Female Prov:_____________Postal Code:_________ Home Phone: ( ) ___________ E-mail: ___________________________ Mothers Work #: ( )______________ Fathers Work #: ( )______________ Camp Session Registering for: ______________ Date of Session Registering for: _____________ Is this your first time at Malagash Bible Camp? Yes No One cabin mates name:___________________________________ A. Camp Fee $ _______._____ B. Canteen 1,2,3 or 4 x $5.00 $ _______._____ C. Total Payment (A + B) $ _______._____ D. Registration Fee $ _____60.00___ E. Total minus Registration (C - D) $ _______._____ For Camp Use Only: The Medical and Conditions forms on reverse side must be filled out as part of the registration application. *------------------------------------------------------------------------------------------------------------------------------* 2004 FAMILY CAMP REGISTRATIONAUGUST 1-7, 2004 Ms./Mr./Mrs.________________________________________Phone ( )__________________ Address:______________________________________Rural St #____________________ City/Town:________________________ Prov:________ Postal Code:_______________________ Adult Names: ___________________________________________________________________ Email:_________________________________________________________________________ Childrens Names: Age: #1 . ___________________________________________________________________________ #2 . __________________________________________________________________________ #3 . __________________________________________________________________________ #4 . __________________________________________________________________________ For Camp Use Only: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Accommodations - Check One Cabin______ Tent Site_____ Trailer Site_____ NOTE: $30.00 Discount for a tent or trailer site. FAMILY SPECIAL $665 A. ____Adults 18 and over x $205.00 $ _______._____ B. ____Youth 7to 17 x $125.00 $ _______._____ C. ____Children 3 to 6 x $60.00 $ _______._____ Children under 2 free D. Total of above (A+B+C) $ _______._____ E. Lesser of D or $665.00 $ _______._____ F. Tent/Trailer Site: $30. or $.00 $ _______._____ G.Total Payment (E - F) $ _______._____ H. Registration Fee $ ____100.00___ I. Total Minus Registration (F - G) $ _______._____ MEDICAL FORM NS Health Card # _________________Expiry Date______________ Does your child have any allergies? Yes No If yes, please list allergies: Does your child need to take medications at camp? Yes No If yes, please list medications: All campers must turn over all medications to the First Aid Attendant at registration. Can Acetamenophen be administered for minor aches and pains? Yes No Does your child have any physical, mental, emotional, or other disabilities that the First Aid Attendant and Camp Director should know about? Yes No Explain Family physician: _______________________Phone:______________ In case of emergency call:________________ Phone:______________ I ___________________________(print Parents name) gives consent for __________________(campers full name) to receive any emergency treatment necessary. Parents/Guardians Signature: ---------------------------------------------------------------- CONDITIONS OF ENROLLMENT 1. The Camp Director reserves the right to dismiss a camper who in his/her opinion is a hazard to the safety and rights of others, or who appears to have rejected the reasonable controls of Camp. 2. Any applicable conditions of custody or visitation must be fully communicated in writing to the Camp, including, if applicable, a photocopy section of any court order referring to visitation rights. The signature on the registration form signifies that both parents/guardians are in agreement with the conditions of enrollment. 3. Care is taken for the safety and good health of campers, but in the event of accident or sickness, Malagash Christian Fellowship/Malagash Bible Camp including the Board of Directors and staff, are hereby released from any liability. Each camper must be covered by Provincial health Insurance orequivalent medical insurance. 4. In the event that a camper requires special medication, x-ray or treatment beyond that which is available at Camp, the parents/guardians will be notified immediately and will becharged with the additional expenses of these required medications and/or treatments. 5. In case of medical emergency, I hereby give permission to a physician selected by the Camp Director to hospitalize, secure proper treatment, and to order injection, anesthesia or medical treatment for my child named above. 6. Malagash Bible Camp requires that campers who have potentially life-threatening conditions, such as peanut allergies, be able to manage their exposure to those conditions or substances, provide two sets of medication, and be familiar with its use and carry the medication in a fanny pack. 7. In case of withdrawal during the camp on a physicians order, two-thirds of the fee for the unexpired term will be refunded. No refund will be made for dismissals due to disciplinary action, late arrivals or early departures. 8. All programs require a minimum number of participants before they will run. In case of cancellation of a session, campers will be notified and all fees paid will be refunded. 9. If a camper wishes to cancel his/her registration, fees will only be refunded if the Registrar or camp is notified fourteen days in advance of the opening date for the particular camp or in the case of an emergency situation. 10. I give permission for Malagash Bible Camp to use any image or likeness of my child for promotional material. SIGNATURE REQUIRED TO PROCESS REGISTRATION I have read, understood and accepted the conditions of enrollment as stated above. DATE _____________PARENT/GUARDIAN SIGNATURE____________________

Mail Applications to: Malagash Bible Camp Make cheques payable to: Malagash Bible Camp

c/o 25 Stonehaven Road

Halifax NS B3N 1G2