Family Camp 2014

Family Camp 2014

Please book for C&C camp by filling in the form below, specify the expected number attending.
$55 - Individual$100 - Couple$160 - Family$25 - Indivitual (single day)$50 - Couple (single day)$75 - Family (single day)
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First Family Member*

First NameLast Name
Second Family Member

First NameLast Name
Child 1

First NameLast Name
Age:
Does your child have any physical, emotional, mental, behavioural concerns or limitations which staff should be aware of?
YesNo
If "Yes" please explain:
Child 2

First NameLast Name
Age:
Does your child have any physical, emotional, mental, behavioural concerns or limitations which staff should be aware of?
YesNo
If "Yes" please explain:
Child 3

First NameLast Name
Age:
Does your child have any physical, emotional, mental, behavioural concerns or limitations which staff should be aware of?
YesNo
If "Yes" please explain:
Child 4

First NameLast Name
Age:
Does your child have any physical, emotional, mental, behavioural concerns or limitations which staff should be aware of?
YesNo
If "Yes" please explain:
Phone Number*

Area CodePhone Number
Cell Number

Area CodePhone Number
E-mail*
Address

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Any other Information we should know.
While every precaution is taken for safety and good health, some sports and activities carry with them the inherent risk of personal injury beyond the risks associated with many of the recreational activities at Ontario Christian Assembly, Inc. I/we understand and accept these risks and agree that by allowing my child/family to participate in those activities, he/she or the family may be taking part in a recreational activity that presents the potential for personal injury.

The safety of your family is our primary concern. Precautions will be taken for the well-being
and protection of all participants at Ontario Christian Assembly, Inc.
I/we, the parents or guardians named below, authorize Dean or one of the Ontario Christian Assembly Inc. Ministry Personnel to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for a participant named above in the event a parent or guardian is not available at the time an emergency occurs.

I/we, named below, undertake and agree to indemnify and hold harmless Ministry Personnel, Ontario Christian Assembly Inc., its Deans and Board of Directors from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Ontario Christian Assembly, Inc., as well as of any medical treatment authorized by the supervising individuals representing the Camp. This consent and authorization is effective only when participating in or travelling to events sponsored by the Ontario Christian Assembly, Inc.
Photos
Please check all boxes below to grant permission for the reasonable use of pictures containing members of your family in any or all of the following ways:
All options listedBrochures/Promotional MaterialsWebsite
CampNewsletterVideotaping
Purposes and Extent
Ontario Christian Assembly Inc. is collecting and retaining this personal information for the purpose of enrolling your family in our programs, to assign children to the appropriate classes or activities, to develop and nurture ongoing relationships with you and your family, and to inform you of program updates and upcoming opportunities at our Camp. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Ontario Christian Assembly Inc. to limit the information collected, or to view your family’s information, please contact us.
I/we have read, understood and agree with the above. (enter your initials below as your signature)
Payments are processed through PayPal. You may pay using an existing PayPal account, or any major credit card / debit card. You may also mail a cheque to:

OCA

PO Box 194

Selkirk, On N0A 1P0
Mail Cheque to OCA (at above address)PayPal (PayPal account, Visa or MC)Other Method
Should be Empty:

Family Camp 2014

Photos

Purposes and Extent