2016 CAMP TAWINGO - CAMPER ORDER FORM Clear Entire Form

Transcription

Clear Entire Form
2016 CAMP TAWINGO - CAMPER ORDER FORM
CAMPER’S NAME:________________________________________________________________________
CAMP SESSION(S):
1ST
1A
1B
2ND
2A
2B
3RD
3A
3B
VA
Male
WJ
Female
TLC
TRAVEL: ARRIVALS (SESSIONS 1B, 2B, 3B – NO BUS or AIRPORT SERVICE) & DEPARTURES (SESSIONS 1A, 2A, 3A – NO BUS or AIRPORT SERVICE)
1ST / 1A ARRIVALS
1B – CAR ONLY
1ST / 1B DEPARTURES
1A – CAR ONLY
2ND / 2A ARRIVALS
2B – CAR ONLY
2ND / 2B DEPARTURES
2A – CAR ONLY
3RD / 3A ARRIVALS
3B – CAR ONLY
3RD / 3B DEPARTURES
3A – CAR ONLY
o CAR
o CAR
o CAR
o CAR
o CAR
o CAR
(Arrival - 11:00 a.m.)
(Departure - 11:00 a.m.)
BUS LOCATIONS:
BUS LOCATIONS:
BUS LOCATIONS:
BUS LOCATIONS:
BUS LOCATIONS:
BUS LOCATIONS:
o Toronto
o KW
o Ottawa
o Toronto
o KW
o Ottawa
o Toronto
o KW
o Ottawa
o Toronto
o KW
o Ottawa
o Toronto
o KW
o Ottawa
o Toronto
o KW
o Ottawa
$79.10
$97.18
$99.44
$79.10
$97.18
$99.44
$79.10
$97.18
$99.44
$79.10
$97.18
$99.44
$79.10
$97.18
$99.44
$79.10
$97.18
$99.44
AIRPORT LOCATION:
AIRPORT LOCATION:
AIRPORT LOCATION:
AIRPORT LOCATION:
AIRPORT LOCATION:
AIRPORT LOCATION:
o Toronto
o Toronto
o Toronto
o Toronto
o Toronto
o Toronto
$98.31
$98.31
$98.31
$98.31
$98.31
$98.31
Arrival from:
___________________
Departure to:
____________________
Arrival from:
___________________
Departure to:
____________________
Arrival from:
___________________
Departure to:
____________________
Arrival Date:
___________________
Departure Date:
____________________
Arrival Date:
___________________
Departure Date:
____________________
Arrival Date:
___________________
Departure Date:
____________________
Arrival Time:
___________________
Departure Time:
____________________
Arrival Time:
___________________
Departure Time:
____________________
Arrival Time:
___________________
Departure Time:
____________________
Flight #:
___________________
Flight #:
____________________
Flight #:
___________________
Flight #:
____________________
Flight #:
___________________
Flight #:
____________________
Airline:
_________________
Airline:
____________________
Airline:
___________________
Airline:
____________________
Airline:
___________________
Airline:
____________________
VISITORS’ DAY HUNTSVILLE EXCURSION – Available to CAMPERS from OUTSIDE ONTARIO, ONLY.
o
o
Visitors’ Day Huntsville Excursion (Campers from outside Ontario, only)
$13.56
Additional Spending Money for Huntsville Shopping
$ 0.00
-----------$ 0.00
Clear Arrival and Departure Method
TOTAL VISITORS’ DAY HUNTSVILLE EXCURSION
0.00
TRAVEL TOTAL: $____________
Clear Entire Form
CAMPER’S NAME:________________________________________________________________________
CAMP SESSION(S):
1ST
1A
1B
2ND
2A
2B
3RD
3A
3B
VA
Male
WJ
Female
TLC
PLEASE NOTE: ALL CAMPERS ARE REQUIRED TO BRING A PADDLE & PERSONAL FLOTATION DEVICE
CANOE PADDLE PURCHASES (Price Includes 13% HST)
Please Check Appropriate Size of Canoe Paddle (Measure from ground to chin)
o 36” / 91cm Canoe Paddle
$36.16
$36.16
$36.16
$41.81
$48.59
$50.85
Clear Canoe Paddle Selection
$53.11
$56.50
$41.81
INTERNATIONAL CAMPER EQUIPMENT RENTALS – Available to INTERNATIONAL CAMPERS, ONLY.
Personal Flotation Device (PFD) Rental
(Check Appropriate Size)
o
o
o
Youth PFD (under 90 pounds/41kg)
Canoe Paddle Rental
(Check Appropriate Size - Measure from ground to chin)
$25.00
Adult S/M PFD (chest 32” – 41”/81cm – 104cm)
Adult L/XL PFD (chest 42” – 49”/106cm – 124cm)
Clear PFD and Canoe Paddle Rental Selection
Sleeping Bag & Pillow Rental
o
Sleeping Bag and Pillow
Clear Sleeping Bag and Pillow Rental Selection
$55.00
o
o
o
o
o
o
o
o
o
36” / 91cm Canoe Paddle
$25.00
EQUIPMENT TOTAL
$ 0.00
Clear Entire Form
CAMPER’S NAME:________________________________________________________________________
CAMP SESSION(S):
1ST
1A
1B
2ND
CAMPER BANK ACCOUNT for CAMPERS, VA, WJ & TLC
2A
2B
3RD
3A
3B
VA
Male
WJ
Female
TLC
(As a guideline only, we recommend $25.00 per camper per week including VA, WJ & TLC)
Please choose applicable option(s) in accordance to the length of session(s) your camper is attending:
o
o
o
o
o
o

Camper Bank Account
(Camp purchases of souvenirs, chapel donations, laundry, etc.)
$25.00
Camper Bank Account
$50.00
Camper Bank Account
$75.00
Camper / VA / WJ Bank Account
(Camp purchases of souvenirs, chapel donations, laundry, VA/WJ special clothing, etc.)
$100.00
Camper / TLC Bank Account
(Camp purchases of souvenirs, chapel donations, laundry, TLC special clothing, etc.)
$200.00
Please DO NOT allow my Camper to make any Camp store purchases.
Our Premiere Registration Opportunity (campers who registered before Nov. 24th) will receive a $50.00 credit in their Camper Bank Account, but may need additional funds as per above.
Clear Camper Bank Selection
0.00
CAMPER BANK TOTAL: $_____________
PAYMENT SECTION
PLEASE INDICATE YOUR PREFERRED PAYMENT OPTION BELOW:
(ALL INTERNATIONAL TRANSACTIONS MUST BE PAID BY CREDIT CARD, ONLY)
o
o
o
o
Enclosed cheque in Canadian Funds payable to CAMP TAWINGO.
Enclosed money order in Canadian Funds payable to CAMP TAWINGO
TRAVEL TOTAL
EQUIPMENT TOTAL
CAMPER BANK TOTAL
:____________________________________________________ Expiry Date:_________
:____________________________________________________ Expiry Date:_________
0.00
Amount of Payment: $__________________________
NAME ON CARD:_____________________________ SIGNATURE:___________________________
o
PLEASE LIST TOTALS FROM EACH SECTION:
I AUTHORIZE CAMP TAWINGO (JACK PEARSE LTD.) TO CHARGE MY CREDIT CARD LISTED ABOVE.
Please note any outstanding balance will be charged to the credit card number listed above at the end of the summer.
We have fun building GREAT kids!
0.00
$_____________
0.00
$_____________
0.00
$_____________
-------------------------
GRAND TOTAL
0.00
$_____________
Clear Entire Form
SUMMER 2016
CAMP TAWINGO - IMPORTANT CONFIDENTIAL INFORMATION ABOUT CAMPERS
TO BE COMPLETED BY PARENT OR GUARDIAN, PLEASE.
Co-operation and confidentiality between Parents and Camp Staff contribute greatly to a more positive experience for each
camper. It is important, therefore, for you to be thorough and conscientious in completing this form. If enough space is not
provided for a particular response, please use extra paper. Thank you! The more we know about your camper, the better
ST
leadership and experience we can provide. PLEASE COMPLETE AND RETURN THIS FORM BY MAY 31 , 2016.
CAMPER’S NAME: _________________________________________ Age at Camp ________
CAMP SESSION:
1
1A
1B
2
2A
2B
3
3A
3B
VA
Male
WJ
Female
TLC
C C
C
C
C
C
C
C
C
C
C
C
A
A
A
A
A
A
A
A
A
A
A
A
Campers who live outside Canada: Please list the e-mail address that we can use to send you scanned correspondence
from
M M
M
M M
M
M M
M
M
M
M
your camper once per week. E-mail Address:
P
P
P
P
P
P
P
P
P
P
P
P
A. FAMILY INFORMATION:
S
S
S
S
S
S
S
S
S
S
S
S
E people
E contact
E us atECampEto ask for
E specific
E information
E
Eabout aEcamper (e.g.,
E his/her
E cabin number).
Note: Sometimes,
S people
S to whom
S we S
S
S willSbe thoseSwhose names
S
S on your camper’s
Please note thatSthe only
will offerSsuch information
appear
Application Form
All
S (parents/guardians/emergency
S
S
S
S contacts).
S
S others
S who wish
S suchS information
S willSbe asked to contact the
family, directly.I
I
I
I
I
I
I
I
I
I
I
I
O O
O
O
O
O
O
O
O
O
O
O
1. Is your Camper Living At Home?
If yes, with:
Both Parents
Mother Only
Father Only
Guardian
N N
N
N
N
N CN
N
NC
N
NC
N
C
Other (please
( specify)
(
(
(
(
(
(
(A
(
( A
(
A(
A
C
2. If A
not at home, Sthen where?
S
S
S
S
S
S
SM S
SM S
MS
M
)
)
)
)
)
)
)
)
)
)
)
)
P
P
P
P
M whom?
With
:
:
:
:
:
:
:
:
:
:
:
:
P there custody
3. Are
arrangements and/or issues of which we should be aware?
S
S
S
S
1
1
1
1
1
1
1
1
1
1
1
1
E
E
E
E
S
4. Any
Brothers?
[names
and
ages,
please]
At
Camp?
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
E
T
T
T
T
T
T
T
T
T
T
T
T
S
S
S
S
S Sisters? [names and ages, please]
Any
At Camp?
I
I
I
I
S
B. CAMPI EXPERIENCE:
1
1
1
1
1
1
1
1O
1
1 O 1
O1
O
A A
A
A
A
A NA
A
AN
A
AN
A
N
O
1. Previous Camping experience(s) (Day and/or Residential) – Year(s)
(
(
(
(
N
Name(s) of Camp(s)
1
1
1
1
1
1
1
1S
1
1 S
1
S1
S
(
B
B
B
B
B
B
B
B
B
B
B
B
)
)
)
)
2. Was
the
experience
satisfactory?
S
:
:
:
:
If )not, why not?
2
2
2
2
2
2
2
2
2
2
2
2
:
C. PERSONAL INFORMATION:
N N
N
N
N
N 1N
N
N1
N
N1
N
1
D
D
D
D
D
D
D
D
D
D
D
D
S
S
S
S or any
1
1. Since the date of registration with Camp Tawingo, have there been any changes in your camper’s eating habits,
T
T
T
Tto likes,
food
concerns
about
which
we
should
be
aware?
Please
note
that
Camp
Tawingo’s
food
service
does
not
cater
S
orT
dislikes, but2to special
diets,
only
(e.g.
lactose
intolerance,
vegan,
vegetarian,
gluten–free,
etc.).
We
have
a
balanced
2
2
2
2
2
2
2
2
2
2
2
and varied menu
A thatAdoes include
A red
A meat,Apoultry,
A and1fish.
A Special
A food
A1 requests
A mustAbe1received
A in writing
1 at least
2 weeks prior to the start of the session.
A
A
A
A
1
2
2
2
2
2
2
2
2
2
2
2
2
A
B
B
B
B
B
B 1B
B
B1
B
B1
B
1
2. Have
there
been
any
physical/health
changes
(e.g.
injuries,
illnesses,
new
diagnoses,
etc.)
since
registration?
Please
B
B
B
B detail:
1
3
3
3
3
3
3
3
3
3
3
3
3
B
R R
R
R
R
R 2R
R
R2
R
R2
R
2
D
D
D
D
D
D
D
D
D
D
D
D
N
N
N
N
2
3. Is camper likely to miss home?
D
D
D
D
N
If D
yes, please elaborate:
3
3
3
3
3
3
3
3
3
3
3
3
A A
A
A
A
A 2A
A
A2
A
A 2PleaseAturn page2over
A
A
A
A
2
3
3
3
3
3
3
3
3
3
3
3
3
A
Clear Entire Form
-2-
4. What are your Camper’s responsibilities around the home?
5. When does your camper usually go to bed?
When does your camper usually wake up?
Is there a bedtime routine about which it would be helpful for us to know?
6. Hobbies, Interests, Extra-Curricular Activities?
7. Member of any team(s)?
Yes
C
If yes, please specify:
A
8. Comfortable with Competition? MYes
C
P
Please explain:
A
No
C
A
No
M
C
P
A
M
M
S
S
P
P
Please explain:
E
E
10. Any Shyness?
Yes
No
S
S
C
C
S
S
S
S
Please explain:
A
A
E
E
IM
IM
S Yes
SNo
11. Any Fears?
C
C
O
O
P
P
S
S
Please explain
A
A
N
N
I
I
12. Is Camper a Bed-Wetter?
If yes:
Rarely
Occasionally
Frequently
M
M
(S
(S
O
O
C
C
C
P
P
S
S
Please Note: Camp Tawingo staff are
E
E
N trained to deal
N
A with bed–wetting inAa discreet and sensitive
A manner.
)
)
S
S
13. Please note your camper’s swimming
( ability:
( Non Swimmer
Advanced
M
MBeginner
MIntermediate
S
S
C
:S
:C
C
C
S
P
P
P
E
A
E
A
D. OTHER INFORMATION:
A
A
I)
I)
S
M
S
M
1O
1
M
M
O
: hopes/expectations
:S
S
S
1. Do you and your camper have special
for Camp this summer?
Please elaborate:
S
P
S
P
P
P
N
N
E
E
E
IT
IT
(1
(1S
S
S
O
S
O
S
S
S
S
S
S
S
N
N
E
1)T
1E
E
E
)T
I your camper that will
I help us understand
I his/her needs and
2. Is there anything else you wish to share with us about
(A
(S
S
A
S
S
:O feel free to write O
Oif necessary.)
provide, wholeheartedly, for his/her:S well-being? (Please
S
Son a separate sheet,
S
S
1
1N
N
N
)1
)I1
I
I(
I
1A
1A
(
(
:B
O
:B
O
O
O
S
S
S
S
N
N
N
N
T
1have my camper’s
1)
) his/her name) appear
)
I Do Not Agree toT
photograph (without
in Camp Tawingo
3.
I Agree
12
12(
(
C
C
(
(
B that we do not
B
: ever use campers’ names
: when using photographs
:
promotional
materials.
(Please recall
for
this
purpose.)
S
S
S
N
N
A
A
S
S
1
1
T
)
T
)
D
D
M
M
)
)
A
A
2
21
1
1
Confidentiality/Privacy
Agreement
:
:
P
P
:S
:
N
N
S
S
12
12
1D permission for
1D
T this information to be
T shared with anyone
T on the Camp Tawingo staff
In signing this document, I am giving
1health, safety and well-being
A
1
S is, in some way,
S responsible forA
1 counsellor’s supervisor,
1
who
my
camper’s
(e.g.
counsellor,
B
B
S
S
E nurses, Camp
E Director, etc.).2
S
S
Camp
21
1
1
T
12
12T
S
S
T
T
2A
2A
A
A
___________________________________________________
B
B
S
S
N
N
1 Signature of Parent
1
I
I
11 or Guardian 1
D
D
2
21
1
A
23
23A
O
O
A
A
B
B
B
B
N
N
R
R
N
N
2
2
1
DWe have fun
1 building GREAT
D
(
(
kids! 12
1
A
A
3
32
2
B
B
S
S
B
B
R
R
N
N
N
23
23
)
)
2D
2D
D
D
2
A
2
A
:
:
2
2
9. Many or few friends?
Clear Entire Form
SUMMER 2016
VISITORS’ DAY CAMPER TRAVEL PERMISSION FORM
SESSIONS 1A, 1B, 2A, 2B, 3A & 3B CAMPERS DO NOT NEED TO COMPLETE THIS FORM.
THIS FORM IS DESIGNED TO ESTABLISH THAT CAMP TAWINGO CAMPERS HAVE OBTAINED
PERMISSION FROM THEIR PARENTS OR GUARDIANS REGARDING THEIR ABILITY TO LEAVE CAMP
ON VISITORS’ DAY.
VISITORS WISHING TO TAKE CAMPERS OUT OF CAMP DURING THE DAY ON VISITORS’ DAY
MUST BE A MINIMUM OF 21 YEARS OF AGE. IF THE VISITOR IS A MINIMUM OF 21 YEARS OF AGE,
BUT NOT A RELATIVE OR THE PARENT OF ANOTHER TAWINGO CAMPER, WRITTEN PERMISSION
IS REQUIRED AT LEAST 24 HOURS PRIOR TO VISITORS’ DAY.
CAMP TAWINGO’S INTENT IS TO ENSURE, TO THE BEST OF OUR ABILITIES, THE CARE AND
SAFETY OF OUR CAMPERS AT ALL TIMES, IN ALL SETTINGS.
THANK YOU, IN ADVANCE, FOR YOUR CO-OPERATION IN THIS IMPORTANT CAMP POLICY.
*
*
*
*
*
*
CAMP SESSION (Please Check)
1
2
3
TLC
C
C
C
C
A
A
A
A my permission to choose to leave the Camp
(Camper’s Name) _____________________________has
M
M
M
M
Tawingo property (for a Visitors’
inPthe vehicle
P Day outing)
P
P of:
C
A
C
M
A
C
P
M
A
P
M
S
C
P
E
S
A
S
E
M
S
C
S
P
IE
A
S
S
O
M
I
S
S
N
P
O
E
(I
N
S
O
S
S
(
S
)N
E
S
I:(
S
)
O
S
S
:N
1)I
(S
:O
1S
T
N
)S
1(
T
:1S
S
T
A
)1
:A
S
1
S
S
S
S
E
E
E
E
Parents or guardians of another S
Camp Tawingo
camper
family.
S
S
S
S
S
S
S
Parents or guardians of_______________________________________,
only.
I Specific
I Camper’s
I
I
Name(s)
O
O
O
O
N
N aunt,Nuncle)______________________________________,
N
only.
Another family member (e.g., grandparent,
(
(
(
( Specific Family Member’s Name(s)
S
S
S
S
My camper is NOT permitted )to leave the
) Camp
) Tawingo
) property on Visitors’ Day.
:
:
:
:
Parents or guardians, only.
In consideration of your permitting my child to leave the Camp Tawingo property in accordance with this
1 Tawingo
1 (Jack
1 Pearse1Limited) and all members of its staff from, and
permission, I hereby release Camp
S
T
S
T
S
T
S
T
agree to indemnify them against, any claim for damages for or arising out of the death of my child or for or
arising out of any injury my child may sustain while away from the Camp Tawingo property.
___________________
DATE
1
A
1
A
1
A
1
A
1
B
1
B
1
B
1
B
______________________________________
SIGNATURE OF PARENT/GUARDIAN
We 2have fun
building
GREAT kids!
2
2
2
N
D
N
D
N
D
N
D
Other Notes

2016 CAMP TAWINGO - CAMPER ORDER FORM Clear Entire Form

Transcription

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