Second Annual Camp out Registration
For more information please contact John Bass:
Thanks to North Bank Potato Farms for their generous sponsorship of our scholarship!
Email address *
Phone number *
Your answer
Number of Adults *
Your answer
Name(s) of Adults *
Your answer
Number of children below 18
Your answer
Name(s) of children
Your answer
Can you provide a ride? Do you need a ride?
Accommodation (Select one) *
Dietary Restrictions (if applicable)
Your answer
Contribution Amount (Suggested amount $50/adult. Children under 18 are free. If you would like to access the scholarship, please indicate here).
Your answer
Preferred Method of Payment
A copy of your responses will be emailed to the address you provided.
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