Canyon Church Camp
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Women's Retreat Registration
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Indicates required field
First Name
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Last Name
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Birthdate (dd/mm/yyyy)
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Alberta Health Care Number
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Address
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City
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Province
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Postal Code
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Email
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Cellular Phone Number
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Home Phone Number
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Work Phone Number
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Emergency Contact Name
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Relationship to Emergency Contact
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Emergency Contact Cellular Number
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Emergency Contact Home Number
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Emergency Contact Work Number
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Do you have any dietary restrictions?
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Yes
No
If yes, please explain your restrictions.
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Do you have a friend that you would like to share a cabin with? If yes, please give us their name and we will do our best to accommodate your request.
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Canyon Church Camp Authorization and Consent
Adult Registration:
I am the person named herein I acknowedge I am capable to engage in all prescribed camp activities, except as noted above, and I agree that I am subject to the rules and regulations of Canyon Church Camp. In the event I am unable to provide consent in the Medical Emergency, I hereby give permsission that medical treatment be obtained. I agree to pay any charges not covered by my Medical Plan, ie. medications, ambulance, etc. I hereby waive all claims against the Canyon Church Camp Association, and is representatives, for any accident or injury that may occur in connection with the events for which I have registered.
I consent that images may be used for camp promotion promotion unless written objection is provided to the Registrar.
I have read the above Canyon Church Camp Authorization and Consent, and agree to abide by all rules and regulations as outlined. I fully understand that submitting this form will be accepted as my legal signature on the form.
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Yes
Your Name
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Date
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Comment
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To ensure payment has been received, please specify the email address you will be using for Pay Pal.
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Please note: Placement of camp cannot be confirmed until payment is recieved.
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