Esperanza Summer Camp Registration 2019
To be filled out by parents or guardians of campers.
Email address *
Registration Deposit
To reserve your spot on the list for your camper(s), please send a deposit of $25 for Kids camp, and $50 for the other camps. The order of acceptance will be based on the order in which we receive deposits. If a camp fills up, priority will go by order of acceptance.

If you cancel at least 7 days before the camp starts, this amount is fully refundable, but if you cancel less than a week prior to the camp, the deposit will not be refunded (unless there is a family or medical emergency). Deposits can be sent to accounting@esperanza.ca. If there is a reason you cannot submit a deposit, please contact camp@esperanza.ca, or phone Esperanza (250 483-4125) and we will figure something out.

Early Bird Rate
There is an early bird rate available until the end of June. Any registration received after that point will be full price. For the 6-8 year old camp, the early bird rate is reduced by $30, and for the other camps it is reduced by $55.
Household/Immediate Family Rate
If you are registering multiple campers from the same household/immediate family, only the first camper will have to pay full price. Each extra camper will get a discount of 10%.
I AM REGISTERING FOR: *
CAMPER'S FIRST AND LAST NAME *
Your answer
CAMPER'S MAILING ADDRESS
Your answer
CAMPER'S BIRTHDATE (month/day/year) *
MM
/
DD
/
YYYY
Where will you drop your kids off? *
MEDICAL NUMBER *
Your answer
PARENT OR GUARDIAN'S NAME *
Your answer
PARENT OR GUARDIAN'S PHONE NUMBER *
Your answer
PARENT OR GUARDIAN'S E-MAIL ADDRESS *
Your answer
EMERGENCY CONTACT NAME AND NUMBER *
Your answer
ALLERGIES/MEDICAL CONDITIONS
Please list allergies, medical concerns, present prescriptions, problems with bedwetting, or any other information that would be beneficial for us to know about your child.
Your answer
PICTURES *
Select the box that applies to you:
Payment *
NOTE: You will receive a payment request form 2 weeks prior to camp. Please DON'T transfer a payment before then. Please indicate how you are planning to pay for camp so that we can send you the necessary instructions? If a Band is sponsoring your camper, please add the name of the Band in the "OTHER" box.
Required
CAMP WAIVER *
Type your name as an agreement.I, ______________________________________, am/are the parent(s) or guardian(s)
Your answer
CAMP WAIVER *
(Please check all the boxes)
Required
I am/are the parent(s) or guardian(s) *
(Your name below.)
Your answer
of ___________________________________________________, who is/are under the age of 19. I fully understand the risks and dangers involved in the programs and experiences offered at the facilities run by ESPERANZA MINISTRIES ASSOCIATION. In consideration of ESPERANZA MINISTRIES ASSOCIATION offering the programs and opportunities to the above named person(s), I agree to assume all risks involved. This release and assumption of risk is binding upon me, my heirs, executors, administrators and successors. *
(Camper's name below.)
Your answer
I have read and clearly understand this liability release. I am at least 19 years old. Participant/Parent/Guardian’s Name *
(Please enter your name, the parent or guardian, as a signature.)
Your answer
Registration Fees
We never want to see finances be the reason someone does not get to come to camp. If it would be, please contact us and we will come up with some solution. Please contact us at camp@esperanza.ca or by phone at 250 483-4125.
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