Camper Registration Form
                   Please complete form as accurately and legibly as you can
         Thank you for choosing Camp Kennebec for the summer of 2014.  We are hard at work 
         developing new activities and special programs so that 2014 is our best summer yet.  To avoid 
         disappointment please mail/e-mail completed forms, deposit, and payments plus 13% HST to 
         Camp Kennebec, 1422 Cox Road, Arden, Ontario, Canada, K0H 1B0.
         Camper’s First, Middle & Last Name
         Camper’s Address (City, Province & Postal Code)
         Camper’s Date of Birth (Day/Month/Year)
         Camper’s Age as of June 30, 2014
         Gender
         Health Card # & Version Code/Expiration Date
         Camper’s School & Grade as of June 30, 2014 
         Which Camps Has Your Child Attended?  When?
         Did your child require a 1:1 ratio?
         Has your child had overnight stays without you?
         Parent or Guardian’s Name (1)
         Parent/Guardian Phone Number
         Parent/Guardian Email Address
         Mobile Number
         Does Camper Live With This Parent/Guardian?
         Parent or Guardian’s Name (2)
         Parent/Guardian Phone Number
         Parent/Guardian Email Address
         Does Camper Live With This Parent/Guardian?
         Mobile Number
         Emergency Contact #1 & Relationship to Camper
         Emergency Contact Phone Numbers
         Emergency Contact Email Address
         Emergency Contact #2 & Relationship to Camper 
         Emergency Contact Phone Numbers
         Emergency Contact Email Address
           1422 Cox Road, Arden, Ontario, K0H 1B0  ●  T : (613)335-2114  ●  F: (613) 335-2988  ●  E: info@campkennebec.com
                    Would you like your child to take part in our academic program for campers who are staying 2 weeks 
                    or longer?  Yes or No
                    We are only able to provide transportation to camp for sessions that start on June 29, 2014.  Please 
                    indicate if your child will be using any of the following:
                    ____  Toronto bus leaves from Seneca College at 9:00 am, please be there by 8:30 am
                    ____  Montreal bus leaves from Fairview Mall at 9:00 am, please be there by 8:30 am
                    ____  Ottawa bus leaves from IKEA at 11:15 am, please be there by 10:45 am
                    ____ I will drive to Camp, please meet at Arden Community Centre at 11:30 am (June 29 only)
                 For all other start dates, please drive campers directly into camp.  At session end, please pick-up your 
                 Kennebecer in camp, between 12pm-2pm, except August 9 when pick up is by 12pm.  
                 2014 Camp Sessions
                   Length        Select Session       Session Start & End Dates
                   6 weeks                            Sunday June 29 to Saturday, August 9
                   5 weeks                            Sunday June 29 to August 2 or Sunday, July 6 to August 9
                   4 weeks                            Sunday June 29 to Saturday, July 26
                   3 weeks                            Sunday June 29 to Saturday July 19 or Sunday July 20 to Saturday August 9
                   2 weeks                            June 29 to July 12, July 13 to July 26, July 27 to August 9
                   1 week                             Various options available, please inquire
                 2014 Fee Schedule 
                 Please circle the session your child will attend (fees exclude 13% HST)
                    Session         Rate                                  Payments & Due Dates
                    6 weeks        $8,750      $2,900 due with enrolment, $2,900 by Feb 1, 2014 & $2,950 by Apr 15, 2014
                    5 weeks        $7,750      $2,584 due with enrolment, $2,583 by Feb 1 & $2,583 by Apr 15, 2014
                    4 weeks        $6,450      $2,150 due with enrolment, $2,150 by Feb 1 & $2,150 by Apr 15, 2014
                    3 weeks        $5,050      $1,700 due with enrolment, $1,700 by Feb 1 & $1,650 by Apr 15, 2014
                    2 weeks        $4,050      $1,400 due with enrolment, $1,325 by Feb 1 & $1,325 by Apr 15, 2014
                    1 week         $2,500      $850 due with enrolment, $850 by Feb 1 & $800 by Apr 15, 2014
                      1422 Cox Road, Arden, Ontario, K0H 1B0  ●  T : (613)335-2114  ●  F: (613) 335-2988  ●  E: info@campkennebec.com
         Enrolment Conditions
          Please mail completed registration form, camper information sheet, signed conditions of 
           enrolment, deposit plus 13% HST payments as early as you can to avoid disappointment.  
           Last season we closed registration early for several sessions as we were at capacity.
          Enrolment forms received on or after February 1, 2014 must include first two payments, 
           while full payment must accompany enrolment paperwork received on or after April 15, 
           2014.  We must receive camp fees prior to campers arriving at camp.
          You can make payments by cheque, credit card, cash or e-transfer.  Please contact the camp 
           office to arrange payment by credit card or e-transfer 
          Our fees do not include the 13% HST.  Please make sure to add the HST to your payments
          Camp fees include camp laundry, tuck shop, out trips, special events and transportation
          There is a $250 sibling discount on stays of two weeks or longer.
         Parent/Guardian’s Signature: _________________________________ Date: _______________
         Print Parent/Guardian Name: _________________________________
           1422 Cox Road, Arden, Ontario, K0H 1B0  ●  T : (613)335-2114  ●  F: (613) 335-2988  ●  E: info@campkennebec.com