Camp Eulogia 2019 - Application Form
SUBMISSION OF THIS FORM DOES NOT GUARANTEE YOUR FAMILY'S SPOT AT CAMP. ONLY BY MAILING THE CAMP DEPOSIT AND FORM WE SEND YOU WILL YOUR REGISTRATION BE COMPLETE (see Camp Application Process below).

The information collected in this form is required for protection of our children, youth, families, and volunteers. All information will be kept in strict confidence and is only available to ministry leaders and supervisors who are responsible for recruitment, training and assignment of our volunteers (except when there is a court order for disclosure of information).

Camp Fees: Pay as you can, except that a non-refundable deposit of $20 per family member is required.
(Cost to Eulogia: $245 per adult, $205 per children 3-12 years of age.) If you require a subsidy, please indicate the dollar amount below and submit before March 15, 2019. All online application forms are due by March 31, 2019.

Camp Application Process:
- register your intent through this form
- you will be emailed the camper registration form upon receipt of the online application.
- return by mail the following: completed camper registration form (for EACH child AND sibling), a cheque for the deposit of $20 per family member, and cheque postdated to July 2, 2019 for the camp fees that you can pay. Please address cheques to Village Eulogia.

Our camp capacity is 12 families per camp. PLEASE NOTE: *BOTH* CAMPS' APPLICATIONS WILL BE PLACED ON THE WAIT LIST.
Family's Last Name: *
Your answer
Name of Parent/ Guardian 1: *
Your answer
Name of Parent/ Guardian 2:
Your answer
Are you the legal guardian for the child/children? *
Address: *
Your answer
Postal Code: *
Your answer
City: *
Your answer
Phone Number (Cell): *
Your answer
Phone Number (Home):
Your answer
Email address: *
Your answer
I am interested in.... *
If camp fee subsidy required, please indicate in dollar ($) amount your family requires. (Subsidies are limited)
Your answer
(1)Name of child joining special needs program: *
Your answer
Date of Birth (MM/DD/YYYY): *
Your answer
(2)Name of child joining special needs program:
Your answer
Date of Birth (MM/DD/YYYY):
Your answer
(3)Name of child joining special needs program:
Your answer
Date of Birth (MM/DD/YYYY):
Your answer
(1) Name of sibling joining siblings program:
Your answer
Date of Birth (MM/DD/YYYY):
Your answer
(2) Name of sibling joining siblings program:
Your answer
Date of Birth (MM/DD/YYYY):
Your answer
(3) Name of sibling joining siblings program:
Your answer
Date of Birth (MM/DD/YYYY):
Your answer
Full Name for emergency contact: *
Your answer
Contact number for emergency contact: *
Your answer
Dietary restrictions for the family? (Please specify if different for individual members): *
Your answer
T-shirt sizes (for each family member): *
Please indicate how many t-shirts of each size. Available sizes are: Youth Small/Medium/Large/Extra-large and Adult Small/Medium/Large/Extra-large.
Your answer
Additional Comments:
Your answer
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