Dorion Bible Camp Registration - 2003

For          |
Office Use:  |                                  Health Card #____________________________
Registration |Paid by cash___, cheque___ or Visa ___                   mm  dd    yy	
Date&Amount  | Female  Male  New to DBC |Age at Camp____  Birthdate:____/____/___
             | 
             |First Name:________________________ Last Name: _____________________________
             |
_____________|Address:__________________________________ HomePhone:_______________________
Fee          |
Date&Amount  |City:____________________ Parent/Guardian's Name:___________________________
             |                                                         
             |Prov.:____ Post Code:_______ Alt. Contact Name/Phone:________________________	
	     |									     
             |
_____________|
E-mail (opt.)_____________________School:____________________Church:______________________ 

Visa # (opt.)_____________________________________________________ Exp. date_____________

Allergies: _______________________________________________________________________________

Cabin Mate Requests: ____________________________________________________________________
(We'll do our best to give you at least your first choice).
Registrations must be rec'd (fax or mail) no later than a week before the desired week begins. A non-refundable, non-transferable deposit of $25 must be included with each reg'n. The first 100 campers to register (with deposit) will receive a free DBC t-shirt.
Week(s) Attending (please circle):   (Bold numbers indicate the week's age range.)    A,B,D,E,F or G = $170   C = $150
A - 12 - 14 (Jul 6 - 12)           B - 11 - 13 (Jul 13 - 19)           C - 6 - 8 (Jul 20 - 24)       D - 9 - 12 (Jul 27 - Aug 2)
E - 8 - 10 (Aug 3 - 9)       F - 9 - 12 (Aug 10 - 16)     G - 14 + (Aug 17 - 23)      H - Canoe Trip (Aug.17-23): 13 - 19 $260
CONDITIONS OF ENROLLMENT
1. The DBC Manager of Operations reserves the right to dismiss a camper who is a hazard to the health and safety of others, or who appears to have rejected the reasonable controls of the camp.
2. The parents or guardians signing this form are those having legal custody over the child. Conditions of custody, if applicable, will be fully communicated to the camp, including a photocopy of the section of any court order referring to visitation rights.
3. Every precaution is taken for the safety and good health of the campers, but in the event of an accident or sickness, Dorion Bible Camp and Conference Centre, including the camp Board and Staff are hereby released from any liability.
4. EACH CAMPER MUST HAVE PROVINCIAL HEALTH COVERAGE OR EQUIVALENT MEDICAL INSURANCE.
5. In case of an emergency every effort will be made to contact parents or guardians. In the event they cannot be reached permission is hereby given to the Executive Director to hospitalize, secure proper treatment, order injection, anesthetic and/or surgery for my child.
6. In the event that a camper requires special medication, X-ray or treatment beyond that which is possible at camp, the parents will be notified immediately and will be charged with the additional expense of transportation and special care.
7. The parent/guardian will notify the camp if this child is exposed to any communicable disease during the three weeks prior to camp attendance.
8. In the case of withdrawal during camp for any medical reason, two thirds of the unexpired fee will be refunded. No refund will be made for dismissal due to disciplinary action, late arrivals or early departures.
9. All campers or their parent/guardian must assume liability for any damage to camp property.

I have read and accept the conditions of enrollment.

Parent/Guardian signature_______________________________________ Date ________________________

Check here if you do NOT want Camp Dorion to use this camper's image in promotional materials. _______

 

 

CAMPER ACTIVITIES: (descriptions on reverse)  WEEK C CAMPERS DO NOT FILL OUT THIS PART. Because p. 2 may become separated from p. 1 write camper's name again here:

PLEASE, have both the camper and the parent involved in these decisions.
Use a "1" to mark your first choices (one different activity per column).
Because your first choice may be unavailable, you also need to mark one 2nd choice
per column with a "2" (and "3" for one 3rd choice per column).
End result: 1, 2 & 3 under "Major"; 1, 2 & 3 under "Mini 1" & 1, 2 & 3 under "Mini 2". 

             MAJOR
(one hour per morning for 5 days)	   	
      
Archery: (First 24 students) --------____	
Car Racing: (First 12)--------____
Crafts: (First 20)----------------____		
Drama: (First 20)-------------____		
Outdoor Survival Skills: (First 12)----____	
Sports: (First 20)---------------- ____		
Working with Wood: --------------------____
------------------------------------------------------------------------------------------------
          MINI 1                                           MINI 2
(one hour per afternoon -Mon&Tues)	  	(one hour per afternoon - Wed &Thurs)
      
Archery: (First 18)------ ____			Archery: (First 18)-------- ____		
Bible Knowledge:-----____			Board Games:------------____
						Crafts: (First 15) ____
Canoeing: (First 12)------____			Canoeing: (First 12)----____
Hackey Sack:---------____			Hackey Sack:--------____
Outdoor Cooking: (First 12)----____ 	        Outdoor Cooking: (First 12)--____
Pellet Guns: (First 16)----____			Slingshots: (First 16)---____
  (No Pellet Guns week E)			   (No Slingshots week E)
Photography: (First 10)------------____	       	Missions: ----------------____
Rocketry: (First 12)-----------____ 		Rocketry: (First 12)--____
Rappelling: (First 8) ---- ____	      		Rappelling: (First 8)-------- ____
  (No Rappelling week E)	      		   (No Rappelling week E)
Street Hockey: (First 18)----- ____    		Street Hockey: (First 18)-----____

How did you hear about Camp Dorion?__________________________________________


Mail to Dorion Bible Camp, Dorion, ON P0T 1K0 For more info. phone 1-800-268-1609 or (before
June) 807-577-5901. Fax 1-807-857-1141
dbccc@northroute.net.    Regarding registration, email rpepper@northroute.net.

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