Silver Lake Wesleyan Camp, Maberly, Ontario

Thank-you for considering LIT Camp. You are in for a great time of learning and personal growth.

I am applying for LIT Camp (please check one)

June 29 to July 21, 2012

July 20 to August 11, 2012

Tell us about you

Name

FirstLast

Address

Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry

Phone Number

(###)#######

Email Address

T Shirt Size

What Children's clubs or programs are you involved in as a helper/leader

Previous Camp Attended

How Many Years

The Church You Attend

This is a generic text block.

In 300 words or less tell us why you want to take the LIT Program.

Do you have any physical or health reasons why you would not be able to participate in activities or perform the duties and activities included in the LIT program?

Please choose

If "yes" please explain

Emergency Contact Information

Parent or Guardian Name required

FirstLast

Relationship to you required

Parent

Guardian

Parent or Guardian Email Address

Parent or Guardian Phone Number

(###)#######

A very important paragraph for your Parent or Guardian to read and sign

Statement of Understanding:

Privacy: Silver Lake Wesleyan Camp (SLWC) gathers information for use solely by SLWC. Personal information will not be given to any third party without your consent. Dismissal: SLWC reserves the right to dismiss the Named Camper who, in the opinion of the Camp is a hazard to the safety and rights of others or who appears to have rejected the reasonable controls of the Camp. Custody: The Parents or Guardians submitting this application have legal custody of the Named Camper. Conditions of custody, if applicable, will be communicated fully in writing to the Camp, including a photocopy of the section of any court order referring to visitation rights. Promotional Material: SLWC and any third party authorized by SLWC may use photo, video, or audio recording of the Named Camper in SLWC authorized promotional material. Campers will not be identified. Lost Items: SLWC is not responsible for personal items lost, stolen or damaged. Activities: Some camper activities may occur off SLWC property and the Named Camper may fully participate in such activities. Medical Treatment: Every camper must have a valid health insurance card (Ontario Health Insurance or equivalent). The Parents or Guardians give permission for the physicians and nurses selected by SLWC to assess and give medical treatment, including prescriptions, when necessary to the Named Camper. In the event the Named Camper requires such medication, x-rays or other treatment beyond that available at the Camp, the Parent/Guardian will be notified and is responsible for any transportation and medical care expenses. In the event of surgery or medical emergency and the Parent/Guardian is not immediately available for consultation, SLWC has permission to secure proper treatment for the Named Camper. This treatment may or may not include hospitalization, injections, IV therapy, anaesthesia or surgery. Waiver: Every precaution is taken for the safety and good health of SLWC campers. In the event of an accident or sickness, SLWC, its Directors, Staff and employees are hereby released from any and all liability.

Parent/Guardian: Signature: Date:

Parent or Guardian: Your name typed in the signateur line indicates that you have read and agree with the Statement of Understanding.

Parent or Guardian Signature

How did you find out about the LIT Program

Payment Options required

Deposit - $100.00

Full Payment - $450.00

Thank you for registering for LIT Camp. Please return to the LIT page and process your payment or send a cheque to Silver Lake Wesleyan Camp, P.O. Box 38, Maberly ON K0H 2B0. See you in the summer!

Silver Lake Wesleyan Camp

LIT Application