Quinte Sports Camp

When: July 8 - 12, 2013

Where: Quinte Alliance Church

Ages: 6 - 12

Cost: $85 before June 15, $95 after

Registration: Register online below or use this application form:

Online Registration

* Required

Title

Parent/Guardian First Name *

Parent/Guardian Last Name *

Home Address *

City *

Province *

Postal Code*

Country *

Home Phone Number *

Email Address *

Camper's First Name *

Camper's Last Name *

Gender *
Male
Female

Date of Birth *

T-Shirt Size *

Additional Camper Information (include name, date of birth, and t-shirt size) *

Emergency Contact Name *

Emergency Phone *

Special Requests

By checking this box I hereby give permission for the above child to participate in all sports camp activities and to receive emergency medical treatment if necessary. I release SU Canada, the church, and all sports camp staff from liability. *
I agree

I give permission for sports camp leaders to take pictures of my child(ren) during activities to use for future summer promotions *
Yes
No

May we include you in future promotions and mailings?
If you do not wish to be contacted please check this box

Name on Card *

Card Number *

Card Expiry *

Card Type *

CCV Number *

Amount *

$85 before June 15

$95 after