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M ath For your convenience,
tuck and GST (which we are being charged for
the first time) have been included in camper fees.

SUMMER 2008 Registration Form

Name: __________________________________________________________________
Grade (as of Sept. ‘08): ____ Gender: M F Birthday (D/M/Y): _____ /_____ /______
Address: _________________________________________________________________
City/Town: ____________________ Prov: _____________ Postal Code: ____________
Home Phone: ( ) ______ - _______ Email: ________________________________
Parent’s/Guardian’s Names: _________________________________________________
Dad’s Work: ( ) _______ - ________ Mom’s Work: ( ) _______ - ________
Alternative Phone: ( ) _______ - ________
You are eligible for a
FREE T-SHIRT
Church you attend (if any): __________________________________________________ if your whole registration is
Town: ___________________________________________________________________ post marked by May 1!
Pastor: ___________________________________ Phone: ( ) _______ - ________
That’s right! Get your whole
T-SHIRT SIZE: Adult S Adult M Adult L Adult XL registration in the mail before
May 1 and you will receive a
Free MLBC T-shirt when you
2008 CAMP SELECTION & SCHEDULE GST IS INCLUDED!
(checkmark one, if registering for more than one camp, separate forms are required for each camp) arrive on registration day.
Adult Day Camp June 28 (starts @ noon - all are welcome) Free will offering
Pancake Breakfast July 1 (starts @ 9am - all are welcome) FREE! *REGISTRATION DEADLINE
Squirt Day Camp July 1 Ages 4-6 $25 for these camps is:
Beach Volleyball Tourn. July 1 (starts @ 1pm. 4 people per team) $40 per team
1 week prior to the start date of your
camp week, however, we’d prefer reg-
Family Camp Junly 4- 6 All ages Free will offeing istrations before June 30th.
Teen 1 July 6-1 Grades 8-12 $215 (The $50 registration fee must
Golfing add $10 Club Rental add $5 accompany this form)
Quest July 14 -19 Grades 5-7 $155
Adventure July 21-26 Grades 4- 6 $155
On the last day of each camp, all
Explorer July 28 -31 Grades 2- 4 $130 parents are invited to a breakfast and
* College & Career Aug. 1-3 Ages 18 -35 $90 closing service.
Teen 2 Aug. 4-10 Grades 7-9 $185
Golfing add $10 Club Rental add $5 BREAKFAST @ 9:00 am
* Ranch Camp Aug. 12-16 Grades 6- 8 $170 SERVICE @ 10:30 am
* Hard Core Ranch Camp Aug. 18 - 24 Grades 8 -10 $210
REFRESH Sept. 19 -21 Grades 7-12 $35
Fall Supper Sept, 19 $10/adults • $5/ages 6-12 • Free/5 and under
OFFICE USE ONLY
Camp Fee (Pre-registration fee is already included in camp price) $ ________
(eg. if you pay $50 today, the remainder for Explorer Camp would be $80) Date Received: ______________
Golf option (Teen 1 & 2 only) add $10 if participating $ ________ Amount Received: ______________
Money Order: ______________
add $5 for club rental if needed $ ________
Cash: ______________
Optional contributions to our capital campaign (tax deductable) $ ________
Cheque: ______________
Optional contributions to our Campership Fund (tax deductable) $ ________
Cheque #: ______________
TOTAL you’re sending today $ ________
Amount Owing: $ ________ Free T-shirt
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Madge Lake Bible Camp
Box 183, Swan River, MB, R0L 1Z0
Office: (204) 937- 3646 Camp: (306) 542-3134 (June 1 - September 1)

MEDICAL INFORMATION
Camper’s Full Name: ______________________________________________________________________________________________
Medical Insurance Number: ____________________________________________ Prov. _______________________________________
Health Problems: _________________________________________________________________________________________________
________________________________________________________________________________________________________________
Medication currently taking: _________________________________________________________________________________________
________________________________________________________________________________________________________________

EMERGENCY CONTACT INFORMATION

Name: _________________________________________________________________________ Phone: ( ) ________ - _________
Doctor: _________________________________________________________________________ Phone: ( ) ________ - _________

Liability Waiver
1. The Camp Director reserves the right to dismiss any camper who, in his opinion, is a hazard to the safety and the rights
of others or who appears to have rejected the reasonable controls of the camp.

2. I am confident that the Madge Lake Bible Camp staff will do their best to give my child necessary support and supervision
needed and I understand that the safety and health rules will be observed. I hereby give the camp personnel authority
to understand that I am financially responsible. Where the camp program involves leaving the camp premises (e.g.
Canoeing, swimming, hiking, etc.), I give permission for my child to participate.

3. I hereby release Madge lake Bible Camp and it’s personnel from all claims for damages arising from any accidents or
injury caused by my child’s participation in the camp program.

4. I give camp personnel the authority to act on my behalf in case of an emergency, including medical treatment. (Parents
will be notified as soon as possible).

5. The parent/guardian submitting this application are those having legal custody over the child. Conditions of custody, if
applicable, will be fully communicated, in writing, to the camp...including a photocopy of the section of any court order
referring to visitation rights.

6. I agree to allow MLBC to share personnal information (name/address/phone number) with churches affiliated with the
camp and CSSM Ministries.

7. The parents or guardians submitting this application give their permission for any video or photographs of camp activities,
which may include their child, to be used in any camp promotional materials and brochures.

PARENT/GUARDIAN’S SIGNATURE: By my signature I confirm that I have read and agree with all points in the liability waiver.

__________________________________________________________________ ____________________________
Parent/Guardian’s Signature Date

$50 pre-registration fee must accompany this registration form.

Please make as many copies of this form as you need, or download from our website below.
Hand them around to Friends and neighbors as well.

www.madgelakebiblecamp.ca