Apc family camp application

2015 ALBERTA PIONEER FAMILY CAMP APPLICATION
[email protected] FAMILY CAMP
REGISTER BEFORE
January 16th
July 31st - August 3rd
and get $50 off per family!
A camp for the whole family!
We can accommodate up to 8 family members per cabin. Participate in activities together as a family. Activities offered are horseback riding, swimming, crafts, wall climbing, canoeing and more! Applications will be received up to the date of camp or until the session is full. Parent Email: (Confirmation will be sent to this address) Mother/Guardian: (Full Name) Father/Guardian: (Full Name) Child's Name: (Full Name) Child's Name: (Full Name) Child's Name: (Full Name) Child's Name: (Full Name) Child's Name: (Full Name) *Please attach separate note if you have more than five children who will attend Family Camp with you.
3rd Party Emergency Contact: Relation to Family: How did you learn about the camp? Has anyone in your family attended Alberta Pioneer summer camp before? SEND PAYMENT AND COMPLETED APPLICATION FOR PROCESSING
Early Bird Deal
Register before January 16th and get $50 off 1. Full payment by Visa or MasterCard. (no deposits with credit card, full payment only please)
2. If paying by cheque, full payment or a minimum deposit of $100 per application, with the
Family Camp
Fee Totals
balance of fees enclosed as post dated cheque, dated no later than June 1, 2015. There will be a fee charged for NSF cheques. Adult (13+)
3. After June 1, 2015 full payment to be made by credit card or money order.
Child (4-12)
Cheque payable to: Pioneer Ranch Camps
Infant (0-3)
Credit Card
Early Bird Discount
Family Camp subTotal
Card Number:
Donate to Alberta Pioneer
Camp Scholarships
CVV Code:
and help another child enjoy the APC experience. Income tax receipts will be issued for donations over $15. We respect your privacy and never sell, trade, rent, or otherwise share personal information. All personal information received by Inter-Varsity Christian Fellowship of Canada is handled with strict confidentiality for the purposes of enrolling your child in Alberta Pioneer Camp and for subsequent communication with you. If you have questions or concerns, please contact us at 403.638.2660.
2014 Inter-Varsity Christian Fellowship of Canada. All Rights Reserved. 2015 FAMILY CAMP APPLICATION
HEALTH & SAFETY
Health and Safety are emphasized at all times at Alberta Pioneer Camp.
We have a qualified medical person on staff and emergency services available within minutes of the camp property.
Please answer the following questions. Attach a detailed note for any that you answer yes.
Does your child have any allergies (food, drug, environmental)?
Does your child have any special health concerns? Yes Does your child have any conditions (mental, physical or behavioural) that require medication to be dispensed at camp? Due to the structure of our program, and for the benefit of your child, Alberta Pioneer Camp requests that medication required throughout the year be sent with your child to camp. Is your child on a medically prescribed meal plan or dietary restriction? Does your child have emotional or behavioural issues that the camp should be aware of? Are immunizations up to date including tetanus booster? Conscience or Religious Exemption Date of last Tetanus Booster: MM-DD-YYYY *If immunizations are not up to date, please plan to have them made current before camp.
Over the Counter Medications during Camp
Alberta Pioneer Camp keeps the following medications for occasional use by campers to be dispensed at the discretion of the medical personnel. Please
indicate with a check mark and sign to give your permission.
Appropriate Cold Formula Dimenhydrinate (Gravol) Acetaminophen (Tylenol) Appropriate Allergy Formula Antidiarrheal Formula Ibuprofen (Advil/Motrin) I give permission for to be given the above medication if required.
Signature of Parent / Guardian Authorization for treatment
1. I hereby authorize Alberta Pioneer Camp personnel to handle any medical problems with my child during his/her stay at the camp.
2. In the event that a camper requires special medication, x-ray, or treatment beyond that which is possible at the camp, the parent will be notified immediately
and will be responsible for any additional expense for additional care or transportation.
3. In case of surgical emergency, I hereby give my permission to the physician selected by the Camp Director to hospitalize, secure proper treatment for, and
order injection, anaesthesia, or surgery for my child named on this application.
4. I will inform the camp medical staff if my child has had a communicable disease within the 3 weeks prior to his/her stay at the camp.
5. Alberta Pioneer Camp has my permission to contact my family doctor.
Signature of Parent / Guardian CONDITIONS OF ENROLMENT
Fee includes all meals while at camp, housing, use of all recreational
1. The parents or guardians submitting this application are those equipment and facilities, instruction in activities, and awards. having legal custody over the child. Conditions of custody, if applicable will be fully communicated in writing to Alberta Pioneer Fee does not include Tuck Shop purchases.
Camp, including a photocopy of the section of any court order referring Financial assistance is available for those who qualify. Assistance is at the
to visitation rights. discretion of the Director. Contact the office for information and a scholarship 2. While every precaution shall be taken to ensure the good welfare application. The deadline for applications is June 30, 2015. and protection of the camper, Alberta Pioneer Camp, its Directors, staff Nut/Peanut Policy Alberta Pioneer Camp cannot guarantee to be a nut/
members, employees, or facilities outside the camp ground, are peanut free environment. We do seek to reduce the risk of exposure and hereby released from any and all liability in the event of any accident therefore do not use or serve peanuts, peanut products or tree nuts on camp or misfortune that may occur to the applicant camper. 3. The Director reserves the right to remove any camper from the property. Nuts or products containing nuts will not be available in our Tuck program who, in their opinion, is a hazard to the safety and rights of Shop. However the food we purchase and serve may contain traces of nut others, or who appears to have rejected the reasonable controls of Alberta Pioneer Camp. This may range from missing an activity to Cancellation Policy Cancellation more than one month prior to the start of
complete dismissal depending on the situation. camp - full refund less $75/week administration fee. Cancellation one month to 4. I give permission for Alberta Pioneer Camp to use any photograph two weeks prior to the start of camp - full refund less $100/week administration or video footage my child is in for promotional materials. 5. The parents/guardians hereby agree to reimburse Alberta Pioneer fee. Cancellation less than two weeks prior to the start of camp - NO REFUND Camp for any damage caused by the applicant camper. (includes camp fees) except for medical reasons with a note from a doctor - full refund less $100/week administration fee. No refund will be made for I have read all pages of this application form, understand the
dismissals due to disciplinary action, late arrivals or early departures. Camp Information, and hereby accept the Conditions of
Withdrawal during camp on physician's orders - will result in the value of fees for the unexpired term being refunded.
Confirmation of Enrolment (what to bring, directions, arrival and departure,
Tuck Shop, regulations and receipt) will be sent to the email or mail address Signature of Parent / Guardian indicated on the application upon receiving your completed registration and payment. Final acceptance of applicant is at the discretion of the Camp Send completed application with payment to:
Alberta Pioneer Camp
Box 660 Sundre, AB T0M 0X0
Members of: Alberta Camping Association Christian Camping International

Source: http://pioneercamps.ab.ca/wp-content/themes/Nova/pdf/2015-Family-Camp-Application.pdf