ChownMemorial&ChineseUnitedChurch

2015SummerCampRegistrationForm

CampInformation

EventDate:Friday,July17th(6:00pm)Monday,July20th,2015
(12:00pm)
AgeRange:Grade812(StartingSeptember2015)
Location:ChownMemorialandChineseUnitedChurch
3519CambieStreet,Vancouver)

TheCampfeeis$75.00andincludes9meals,aCamp
ForOfficeUseOnly
Tshirtand4daysoffun.Weacceptregistrationformsby
emailtoCMCUCJoshuaFellowship@gmail.com,throughfax FormSubmitDate:
at6048767114,orbyinpersondropoff.Registrationfees
ConfirmPaid:
canbepaidthroughcashorcheque,madepayableto
Y[]N[]
JoshuaFellowshiporthroughdirectdeposittoaccount
PaymentMethod:
number07828145404atBMO.
Youmustbeableto
provideareceiptconfirmingyourpaymentforittobe
Cash
Cheque
DirectDeposit
accepted.Campersspotwillonlybereservedwhenboth
theregistrationformandthepaymentarereceived.
PaymentSubmitDate:
Failuretoabidebytheserulesmayresultinlost
payments.

CamperInformation
FullName

DateofBirthMM

EmailAddress
BCCareCardNumber

DD

YYYY

Sex

[]M[]F
GradeEnteringFall2015

Allergies/MedicalConditions/CurrentMedications

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Parent/GuardianInformation
FullName

Relationship

HomePhoneNumber

WorkPhoneNumber

Address
City (Select

City)

Province (Select)

PostalCode

Email

EmergencyContactInformation
EmergencyContact#1
HomePhoneNumber

Relationship
WorkPhoneNumber

EmergencyContact#2
HomePhoneNumber

Relationship
WorkPhoneNumber

Miscellaneous

TshirtSize:[]S[]M[]L[]XL

Pleasetellushowyouheardaboutourcamp:

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CodeOfConduct
ThesafetyofeachindividualintheprogramisoftheutmostimportancetoCMCUC.Eachregistrant
mustrecognizeapersonalresponsibilitytolearnandfollowatalltimesthesafetyandotherrules
establishedbyCMCUCleaders.Iherebyagreethatanybehaviourthatplacesthecamperorothersat
riskmayresultinhis/herimmediatedismissalfromtheprogram.Further,ifdismissedfromthe
program,Iagreetocoveranyexpense(s)arisingfromsuchdismissal.Iherebyacknowledgeand
agreethatnorefundwillbegrantedfordismissalorremovaloftheregistrantathis/herrequestbefore
theendofaprogramsession.Inordertoensurethesafetyandwellbeingofallindividuals
participatingintheprogram,CMCUCreservestherighttoaltertheprogramatanytimewithoutnotice
orcompensation.
Parent/GuardianSignature

Date

Parent/GuardianConsent
PhotoRelease
Duringthecamp,CMCUCleadersandhelperwilltakeavarietyofphotographsand/orvideoofcamp
activities.Thesephotos/videosmaybepostedinthecamp'sonlineFacebookpage,orusedfor
promotionalpurposes.
I,theundersigned,onbehalfofmyselfand__________________________
(childsname),givepermissiontoallowphotographs/videotobetakenofmychildduringcamp
activities.
Ialsogivemyconsent(and/orconsentonbehalfof,andaslegalguardianforaminorchild)
totheuseofanyphotographstakenmychildbyCMCUC,ortheirrepresentatives,tobeusedfor
editorialand/orpromotionalusesonly.

Participation
I,theundersigned,onbehalfofmyselfand_______________________(childsname),shall
indemnify,holdfreeandharmless,assumeliabilityfor,anddefendCMCUC,itsagents,servants,
employees,officers,directors&allsummercampcoordinatorsfromanyandallcostsexpenses,
includingbutnotlimitedtoattorneysreasonableinvestigativeanddiscoverycosts,courtcostsandall
othersums,whichCMCUC,itsagents,servants,employees,offices,directors&allsummercamp
coordinatorsmaypayorbecomeobligatedtopayonaccountofany,allandeverydemandfor,claim,
orassertionorliability,oranyclaimoractionfoundedtherein,arisingorallegedtohaverisenoutof
________________________(childsname)suseofrealorpersonalpropertybelongingtoCMCUC,
itsagents,servants,employees,officers,directors&allsummercampcoordinators,orbyreasonof
____________________(childsname)sparticipationintheCMCUCSummerCamp.
(ThewholeeventisundercoveredbyCMCUCChurchInsurance)

Bysigningmyname,Ihaveread,understandandagreetoallCMCUCpolicies,termsandconditions
ofregistration.
Parent/GuardianSignature

Date

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ForParents/GuardianstoKeep
ChurchContactInformation
ChurchPhoneNumber:6048767114
Rev.KaoPhoneNumber:6046038077
CampCoordinatorPhoneNumber:7789964999(Joshua)
SummerCampEmail:CMCUCJoshuaFellowship@gmail.com

CampInformation
EventDate:Friday,July17th(6:00pm)Monday,July20th,2015(12:00pm)
AgeRange:Grade812(StartingSeptember2015)
Location:ChownMemorialandChineseUnitedChurch(3519CambieStreet,Vancouver)
TheCampfeeis$75.00andincludes9meals,aCampTshirtand4daysoffun.Weaccept
registrationformsbyemailtoCMCUCJoshuaFellowship@gmail.com,throughfaxat6048767114,
orbyinpersondropoff.Registrationfeescanbepaidthroughcashorcheque,madepayableto
JoshuaFellowshiporthroughdirectdeposittoaccountnumber07828145404atBMO.
Youmust
beabletoprovideareceiptconfirmingyourpaymentforittobeaccepted.Campersspotwill
onlybereservedwhenboththeregistrationformandthepaymentarereceived.Failureto
abidebytheserulesmayresultinlostpayments.

Checklist

Clothestolast4days(includingjacketsandouterwear)

RunningShoes

Sandals/Flipflops

SelfHygieneProducts

PersonalMedication

BCCareCard

SleepingBags(AirBed/Mattressifpossible)

Bible(ifpossible)

ASmile:)

Pleasedonotbringanyelectronicswithyou,exceptforpersonalphones.Phonescannotbeused
duringcampactivitiesunlessspecified,atriskofconfiscation.

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