Registration | Golden Lake Camp

Camper Information

The person completing this form is*

Parent/Guardian
Sponsoring Agency

Name*

First Last

Birthdate*

Age*

Please enter a number from 6 to 18.

Gender*

Address*

Street Address Address Line 2 City Province Postal Code

Attended GLC Before?*

Yes
No

Religious Affiliation*

Parent(s)/Guardian(s) Name(s)*

First Last

Parent(s) Email*

Must be an email you check regularly. Important confirmations and updates will be sent to this address.

Parent(s) Phone - Primary Number*

Parent(s) Phone - Alternate Number*

Emergency Contact*

First Last

Emergency Contact Phone*

Choice of Camp and Rates

Choices of Weeks and Dates*

Junior 1 July 3 - 9
Junior 2 July 10 - 16
Intermediate 1 July 17-23

Rate you will pay*

$420 (1st camper - one week)
$360 (Additional camper, or an additional week for 1st camper)
Requesting Geared-to-income (further down on form)
Other amount (as arranged with registrar)

If this is an additional camper, who is the previous camper?

Agency Rate Product

Price:

Rate

Plus Deposit

Price: $ 0.00 CAD

Geared to Income

Our "Geared-to-Income" and "Extended-Payment" Plans guarantee that no child who wishes to attend Golden Lake Camp is ever turned down for financial reasons. Simply complete the section below and send in the form. Our registrar will then register your child for camp, and contact you by phone or email, to work out with you a rate you can afford, or design an "Extended-Payment plan that will work for you. If you have questions, call us at 1-888-659-2267, or email us at goldenlakecamp@gmail.com.

Which of the following best describes your family's situation?*

Please briefly explain your situation*

How should we contact you?*

By phone
By email
Either is fine

PLEASE NOTE: When we contact you, all information we receive is confidential.

Like to donate to our Camper Subsidy Fund?*

Our Camper Subsidy Fund is used to help children who would otherwise be unable to attend camp for financial reasons. A tax receipt is available for all such donations.

Yes, I would like to donate
Sorry, not this year

Donation Amount

Need a receipt for tax purposes?*

Yes
No

Other Helpful Information

Does this camper have any serious allergies / medical conditions / mental health issues / behavioural issues (A detailed health form will be sent to you later)*

Details you would like us to know

Also inviting a friend?*

No
Yes

Like to be in the same cabin/tent as a friend? (Indicate below--one name only, please.)

About Vaccination, is this camper

Fully vaccinated
Partially vaccinated
Unvaccinated
Would rather not disclose

(We're asking in the unlikely case of an outbreak, when we would need to report to the area's Medical Officer of Health, who might request this information)

How many different ways did you hear about Golden Lake camp? Please check all that apply*

Other

Paying for your child's attendance

How do you plan to pay*

Note: You will be directed to PayPal to submit the payment using your credit card
(a PayPal account is not needed)

Note: You have selected Payment by "Other Arrangement". We will contact you to finalize details.

Note: You have selected Payment by "Geared-to-income". We will contact you to finalize details.

Note: Send your e-transfer to registergoldenlake@gmail.com.
Please include the camper's name and week of the camp

Security Question: Please enter "Deacon" as the answer to your security question, and you can use "Where is the camp?" as your question.

Note: Cheque should be payable to Golden Lake Camp.

Mail to:
Mary Wales, Golden Lake Camp Registrar
94 Ungar Island Rd.,
Desoronto, ON
K0K 1X0

Do you plan to submit the full amount, or a $50 deposit?

About refunds: A full refund, minus a $50 administration fee, is available up to two weeks before the child's planned arrival time at camp, or up to the day of arrival, in the event of a confirmed medical or family emergency.

Deposit ($50)*

Price:

Sponsoring Agency Information

Name of Agency to be Billed*

Agency Contact Name*

Agency Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Agency Contact Email*

Agency Contact Phone*

Prove you're a human...

Please enter the text you see below into the box, to prove you're a human.

Total

$ 0.00 CAD

Note: A $50 Deposit will be the payment requested at this time.