Camp White Pine Pre-Registration Form

Camper 1’s name *

First

Last

Camper 2’s name

First

Last

Camper 3’s name

First

Last

Camper 1’s date of birth *

Camper 2’s date of birth

Camper 3’s date of birth

grade date Address

What grade is Camper 1 in? *

If between grades, list the grade the Camper will be in at the start of the next school year.

What grade is Camper 2 in?

If between grades, list the grade the Camper will be in at the start of the next school year.

What grade is Camper 3 in?

If between grades, list the grade the Camper will be in at the start of the next school year.

Which session(s) are you interested in?

Parent/Guardian Name *

First

Last

Parent/Guardian Email *

Parent/Guardian Phone *

Address *

Street

City

Province

Postal Code

Permission & Agreement *

I give the Camper stated here permission to attend this camp pursuant to all the terms and regulations that apply.

I agree to the following charge *

Along with this form, please e-transfer a deposit of $100 (per camper/per session) to brookeaverill@hotmail.com to complete your registration.