YWCA YoWoChAs Outdoor Education Centre
Mother Daughter Weekend Camp Registration Form
(Please fill out one form per family.)
Weekend Date: _________________________
Mother:
Name:_______________________________ Address: _____________________________ ____________________________________ City:________________________________ Province:_________ Postal Code: _________ Day Phone Number:_____________________ Evening Phone Number: _________________ Cell Phone Number: ____________________ |
Birthdate: ___________________________ Food Allergies / Medical Notes: |
| Email:________________________________ |
Daughter(s)
| Daughter #1 | Daughter #2 | |
| Name: | ||
| Birthdate: | ||
Food Allergies/Medical notes
|
||
Address: (only if different than Mother's) |
If there are additional daughters in the family, please add additional sheets
Fee Calculation:
| # Adults (18 yrs and older) | @ $130 | = | |
| # Children (under 18 yrs) | @ $125 | = | |
| # T-Shirt(s) | @ $18 | = | |
| # Hat(s) | @ $16 | = | |
| Total |
Method of Payment: circle one Cheque Cash VISA Mastercard Credit Card #: ___________________________________ Expiry Date: ______________ Name on Card:_____________________ |
Return completed forms to: YWCA YoWoChAs Outdoor Education Centre Box 313, Fallis AB T0E 0V0 Fax: 780-892-2888 email: yowochas@ywcaofedmonton.org (do NOT send credit card info via email) |
Office Use Only: Received: |
Office Use Only: Package Sent: |