Maple Grove Christian Retreat Centre: Family Camp Registration Form
Individual Registration form for Maple Grove Family Camp
Section 1 is for any aged camper; section 2 must be completed for campers under 18 years of age.
1. Camper's First Name *
Your answer
2. Camper's Surname *
Your answer
3. Lot/Cabin/Trailer/Dorm # *
Your answer
4. Email address (use parent/guardian's email address if under 18) *
Your answer
5. Phone number (use parent/guardian's phone number if under 18) *
Your answer
6 A. Mailing address: Appartment Number, if applicable
Your answer
6 B. Mailing address: Street Name and Number *
Your answer
6 C. Mailing address: City/Town/Village *
Your answer
6 D. Mailing address: Province/State *
Your answer
6 E. Mailing address: Postal Code/ZIP Code *
Your answer
7. Are you new to Maple Grove Family Camp? *
8. Media Release Consent: I, the parent/guardian of, or individual listed in #1, hereby agree and give my permission for Maple Grove Christian Retreat Centre and/or partners to record, film, photograph, audiotape or videotape my/my child's name, image, work, and performance (hereinafter collectively referred to as "Works" and to display, publish or distribute these Works for the purpose of publishing, posting on the Maple Grove website, posting at churches, posting on social media sites and/or for broadcasting on television or radio as determined by Maple Grove. I hereby waive any right to approve the use of these Works now or in the future, whether the use is known to me or unknown, and I waive any right to any royalties related to the use of these Works. I understand that the Works may appear in electronic form on the internet or in other publications outside of Maple Grove's control. I will not hold Maple Grove responsible for any harm that may arise from such unauthorized reproduction. *
Is the person listed in #1 eighteen (18) years of age or older?
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