Name and birth date of individual
First Name *
Last Name *
Birthdate *
Program *
Girls Program
Boys Program
Parent or Guardian residence and contact information
Telephone numbers
Parent/Guardian Name *
Day *
Evening
Cottage
Residence information of individual
Mobile
Address *
City *
Province *
Postal Code *
Country *
Select country Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-bissau Guyana Haiti Heard and Mc Donald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Barthelemy St. Eustatius St. Helena St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand The Democratic Republic of Congo Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe
Camp Registration
All registration include tuck
Dates and Locations *
--Select-- July 2 to 6 - VBS – Kawartha Settler’s Village $0.00 July 9 to 14 - West Guilford Day Camp - Ages 6 to 12 - $100.00 July 16 to 20 - Minden Area Camp - Ages 6 to 12 - $100.00 July 23 to 27 - Coboconk Day Camp 1 - Ages 6 to 12 - $100.00 July 29 to Aug 4 - Resident Camp –(YLCC) - $400.0 Aug 6-10 - Coboconk Day Camp 2 - Ages 6 to 12 - $100.00 August 13-17 - Haliburton Day Camp - Ages 6 to 12 - $100.00 August 20-24 - Eagle Lake Day Camp - Ages 6 to 12 - $100.00
Day Camp Family Discount This is my 2nd+ camper of my family attending Day Camp.
--Select-- 2nd Camper of Family - $10.00 Day Camp discount 3rd Camper of Family - $10.00 Day Camp discount 4th Camper of Family - $10.00 Day Camp discount 5th Camper of Family - $10.00 Day Camp discount
For ages 6 to 12
Age of individual *
6
7
8
9
10
11
12
13
14
15
16
Day Camps – Skills & Activities Preferences
If you have chosen the Day Camp, please number your top 4 activities below, and the 4th one will be the alternate activity.
Archery
Drama
Crafts
Canoes
Kayaks
Mountain Bikes
Trampoline
Cub Cars
Swimming lessons*
Swimming lessons are at Coboconk and Minden locations. Please check with the office for additional locations. Choosing a swimming lesson will register your child for 5 swimming lessons for an additional $40.00.
Current Swimming Level
--Select-- New Swimmer - 5 Swimming Lessons - $40.00 SK1 - 5 Swimming Lessons - $40.00 SK2 - 5 Swimming Lessons - $40.00 SK3 - 5 Swimming Lessons - $40.00 SK4 - 5 Swimming Lessons - $40.00 SK5 - 5 Swimming Lessons - $40.00 SK6 - 5 Swimming Lessons - $40.00 SK7 - 5 Swimming Lessons - $40.00 SK8 - 5 Swimming Lessons - $40.00 SK9 - 5 Swimming Lessons - $40.00 SK10 - 5 Swimming Lessons - $40.00
Residential Camps – Skills & Activities Preferences
Campers will rotate through activities run by YLCC – ropes courses, wall climbing, leadership training, cooperative initiatives, canoes/kayaks and one activity period run by Monarch.
Choose 1 activity and 1 alternative for the Monarch run period.
Drama
Crafts
Cub Cars
Bottle Rockets
Trampoline
Parent/Guardian consent - I give consent for the registered camper...
1) ...to attend the selected camp and participate in the activities listed. *
Yes
No
2) ...to receive any medical treatment deemed necessary by the nurse or EMT on duty. *
Yes
No
3) ... to have pictures or videos taken of the camper during camp. *
Yes
No
4) ... to allow the pictures or videos taken of the camper to be used for the camp's promotional materials. *
Yes
No
5) ...for registration information to be kept for the sole use of the camp in serving my camper. *
Yes
No
Form Submit
Reply-to Information
Sender name *
Email *
Comment No private information
Credit Card Number*
Expiration Date*
01 02 03 04 05 06 07 08 09 10 11 12 / 2012 2013 2014 2015 2016 2017
Card (CVV) Code*
Card Type*
Visa MasterCard Discover American Express
Card Holder Name*