Register

You now have several options to register. For Kids Kamp and Youth Camp use the form below or print and mail forms available at right. For Family Camp please contact dburns@ns.aliantzinc.ca.

Camp selection

Ages 7 - 12
June 29 - July 3		 KIDS KAMP 2010
$225 (Super Savings Rate until June 7th is $200)
Ages 12 - 18
Aug 2 - 7		 YOUTH CAMP 2010
$225 (Super Savings Rate until July 5th is $200)

Camper information

First Name*
Last Name*
Gender*
Birth Date*
Requested Room-mate*
Room-mate has agreed* Yes
Not Yet

Mailing Address

Address*
City or Town*
Province*
Postal Code*
Phone* ( ) -
Email Address*

Home Church

Church name*
Pastor*

In Case of Emergency

Contact*
Phone* ( ) -
Health Card No*
Medication
Allergies

Payment

Camp fee is $225. (Super Savings rate is $200) This amount will be charged to your credit card and appear on your statement as Pentecostal Assembly of Canada.

If you prefer to register with Credit Card via telephone, please call 1 (902) 895-4212.
Canteen Allowance
KIDS KAMP ONLY		 $ 
Method of Payment*
 Mastercard
Visa
Card Number*
Expiry Date*
Cardholder Name*

Parental Release

I hereby give my permission for my child to attend KIDS KAMP 2010 or YOUTH CAMP 2010 (as indicated above). Further, I certify that the information on this form is accurate. I understand and agree that the KIDS KAMP 2010 or YOUTH CAMP 2010 leadership can exercise authority, and administer discipline, to my child in the event of misbehavior. I hereby release the Maritime District of the Pentecostal Assemblies of Canada, including its agents, employees, and volunteers from liability for injury or illness, as a result of accident, illness, or incident during this event.

Please Note: Unless otherwise stated in writing, registration for Kids Kamp or Youth Camp is implied consent to be photographed. Any photographs taken during this week may be used to promote Kids Kamp or Youth Camp in Maritime of the PAOC publications and/or promotions.

My pastor is aware of this application and has approved my child to attend this Camp.

Yes, I agree.

General Comments