Esperanza Summer Camp Registration 2022

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To be filled out by parents or guardians of campers.

Email *

Registration Deposit

To reserve your spot on the list for your camper(s), please send a deposit of $25 for Kids camp, and $50 for the other camps. The order of acceptance will be based on the order in which we receive deposits. If a camp fills up, priority will go by order of acceptance.

If you cancel, the deposit will not be refunded (unless there is a family or medical emergency). Deposits can be sent to accounting@esperanza.ca. If there is a reason you cannot submit a deposit, please contact camp@esperanza.ca, or phone Esperanza (250 483-4125) and we will figure something out.

Early Bird Rate

There is an early bird rate available until the end of June. Any registration received after that point will be full price. For the 6-8 year old camp, the early bird rate is reduced by $30, and for the other camps it is reduced by $55.

Household/Immediate Family Rate

If you are registering multiple campers from the same household/immediate family, only the first camper will have to pay full price. Each extra camper will get a discount of 10%.

I AM REGISTERING FOR: *

KIDS CAMP (GIRLS CABIN): 6-8 yrs (July 24 - 26) $120

KIDS CAMP (BOYS CABIN): 6-8 yrs (July 24 - 26) $120

BOYS CAMP: 9-12 yrs (July 28 - August 2) $280

GIRLS CAMP: 9-12 yrs (August 4 - 9) $280

TEEN CAMP (GIRLS CABIN): 13-18 yrs (August 11 - 16) $280

TEEN CAMP (BOYS CABIN): 13-18 yrs (August 11 - 16) $280

CAMPER'S FIRST AND LAST NAME *

CAMPER'S MAILING ADDRESS

CAMPER'S BIRTHDATE (month/day/year) *

YYYY

Where will you drop your kids off? *

Zeballos

Tahsis

Other:

MEDICAL NUMBER *

PARENT OR GUARDIAN'S NAME *

PARENT OR GUARDIAN'S PHONE NUMBER *

PARENT OR GUARDIAN'S E-MAIL ADDRESS *

EMERGENCY CONTACT NAME AND NUMBER *

ALLERGIES/MEDICAL CONDITIONS

Please list allergies, medical concerns, present prescriptions, problems with bedwetting, or any other information that would be beneficial for us to know about your child.

PICTURES *

Select the box that applies to you:

Permission to use photos of your child in Esperanza Ministries promotional material.

Please do not use photos of my child for Esperanza Ministries promotional material.

Payment *

Note: Payment will be expected upon campers arriving at camp. Registration will not be considered completed until a deposit is paid ($25 for Kids Camp, $50 for each other camp). Please send the deposit by email money transfer to accounting@esperanza.ca.

I will send an e-transfer to accounting@esperanza.ca

I will send a payment with my camper.

Other:

CAMP WAIVER *

Type your name as an agreement.I, ______________________________________, am/are the parent(s) or guardian(s)

CAMP WAIVER *

(Please check all the boxes)

I acknowledge that the activities associated with summer camp at a remote location include outdoor hikes, water sports, and ocean based transportation to and from the locations and that these involve both foreseeable and unforeseeable risks that could result in personal injury or death.

I fully understand the risks and dangers involved in the activities and events associated with attending the summer camps put on by ESPERANZA MINISTRIES ASSOCIATION.

I DECLARE that by allowing the below named person(s) to participate in the summer camps and the transportation provided by ESPERANZA MINISTRIES ASSOCIATION that I assume all risks and will hold the said association, its directors, members, employees, volunteers and agents harmless from any liability whatsoever which may arise out of such camp activities.

I also agree to indemnify ESPERANZA MINISTRIES ASSOCIATION from any legal action brought upon them as a result of any injuries suffered by me or the below named person(s) in the summer camp and should ESPERANZA MINISTRIES ASSOCIATION be required to incur any legal costs, I agree to indemnify them for all such costs on a solicitor client basis.

I realize that by signing this release I am prohibited from commencing a lawsuit against ESPERANZA MINISTRIES ASSOCIATION, its directors, members, employees, volunteers or agents, for any negligence on their part which gives ruse to injury to me or to the below named person(s).

Required

I, _______________________________________________, am/are the parent(s) or guardian(s) *

(Sign your name below)

of ___________________________________________________, who is/are under the age of 19. I fully understand the risks and dangers involved in the programs and experiences offered at the facilities run by ESPERANZA MINISTRIES ASSOCIATION. In consideration of ESPERANZA MINISTRIES ASSOCIATION offering the programs and opportunities to the above named person(s), I agree to assume all risks involved. This release and assumption of risk is binding upon me, my heirs, executors, administrators and successors. *

(Camper's name below.)

I have read and clearly understand this liability release. I am at least 19 years old. Participant/Parent/Guardian’s Name *

(Please enter your name, the parent or guardian, as a signature.)

Registration Fees

We never want to see finances be the reason someone does not get to come to camp. If it would be, please contact us and we will come up with some solution. Please contact us at camp@esperanza.ca or by phone at 250 483-4125.

Send me a copy of my responses.

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