YWCA YoWoChAs Outdoor Education Centre

Mother Daughter Weekend Camp Registration Form

(Please fill out one form per family.)

Weekend Date: _________________________

Camper #1/Mother:

First Name: ______________________   Last Name: _______________________

Address: __________________________________________________________

City: ________________________ Province : ________ Postal Code: ___________

Phone Number (day): ________________ Phone Number (eve): _______________

E-mail address: _____________________________________________________

Food Allergies/Medical Notes: __________________________________________

Camper #2/Daughter:

First Name: ______________________   Last Name: _______________________

Birthdate: _______________

Address: __________________________________________________________

City: ________________________ Province : ________ Postal Code: ___________

Food Allergies/Medical Notes: __________________________________________

Camper #3/Daughter:

First Name: ______________________   Last Name: _______________________

Birthdate: _______________

Address: __________________________________________________________

City: ________________________ Province : ________ Postal Code: ___________

Food Allergies/Medical Notes: __________________________________________

If there are additional campers in the family, please add additional sheets.

Fee Calculation:

# Adults (18 & Older) ____ @ $100 = ______

# Children (Under 18) ____ @ $ 85 = ______

# T-shirts     ____ @ $ 17 = ______

# Hats     ____ @ $ 15 = ______

TOTAL ________

Method of Payment: circle one

Cheque     Cash     VISA     Mastercard

Credit Card #: ___________________________________

Expiry Date: ______________

Name on Card: ___________________________________

Office Use Only:

Received:   

Package Sent: