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Camp Awesome 2011

MAIL THIS FORM ALONG WITH REGISTRATION FORM:


SIGNED LIABILITY WAIVER TO:
M/F
DAYTRIPPING @ ROCKWOOD PARK CHILD’S FULL NAME: AGE
PO BOX 22075- LANSDOWNE RPO
SAINT JOHN, NB, E2K 4T7
ADDRESS CITY/TOWN POSTAL CODE

OR DROP IT OFF AT:


BIRTH DATE (DD/MM/YY) MEDICARE NUMBER EXPIRY
LILY LAKE PAVILION (LOWER LEVEL)
55 LAKE DRIVE SOUTH
ROCKWOOD PARK, SAINT JOHN PARENT/GUARDIAN NAME PHONE NUMBER

OR BY FAX AT: EMAIL ADDRESS

(506) 657-2102
EMERGENCY CONTACT RELATIONSHIP PHONE NUMBER

ALLERGIES/ MEDICAL CONDITIONS:


FOR MORE INFORMATION
CALL
(506) 657-8747

OR EMAIL
info@daytrippingnb.com

OTHER INFORMATION WE SHOULD KNOW ABOUT YOUR CHILD:

WEEK:
TH ST TH TH
JUNE 27 - JULY 1 JULY 4 – JULY 8TH JULY 11 – JULY 15TH

TH ND TH TH ST
JULY 18 – JULY 22 JULY 25 – JULY 29 AUGUST 1 – AUGUST 5TH

TH TH TH TH ND
AUGUST 8 – AUGUST 12 AUGUST 15 – AUGUST 19 AUGUST 22 – AUGUST 26TH

Attachments:
Signed Liability Waiver
Method of Payment:
I have enclosed a cheque (made out to DayTripping @ Rockwood Park)
I will visit DayTripping @ Rockwood Park to pay by cash, debit or
VISA/Mastercard. (payment required to confirm your child’s registration)
$50 administration fee applies to all cancellations.
llations. No refunds within one week of camp
start.