SOUTH-CENTRAL DISTRICT OF SDA

HERITAGE CAMP 2012 REGISTRATION FORM

Theme: “Rekindling the Flame”
Venue: San Sauveur Primary School Building
Date: February 17th to 21st, 2012

Please tick the appropriate box
Age range: [0-4] [5-15] [16 and above]
Gender: [male] [female]

ALL BLANK SPACES must be filled in.

Surname: ……………….….. Other Names: ……………....…………

Address: ………………………………………………………….………

Telephone / Email: ……………………………………………….……..
Married [ ] Single [ ] Engaged [ ] Parent [ ] Child [ ]
Are you a SDA church member? [ ]. Which?: ……………………...
List any medical challenge which may hinder full camp participation: …………………………………………………………………….……….
List any dietary restriction: ………………………………………….….

I HEREBY AGREE TO COMPLY WITH CAMP RULES

Camper signature: …………………………………………………..…..

First Elder signature: …………………………………….……

1. All completed registration forms must reach your AY Leader no later than one week BEFORE camp.
2. Registrations Forms MUST be signed by Camper and First Elder
3. Camp Fees and other monies MUST reach your AY Leader by February 4th, 2012.
4. Campers 12 years and under MUST be accompanied by parents/guardians.
5. Campers aged 0 to 4 must be chaperoned by a Camper who pays the Adult Camp Fee.
6. Bible and Church/SDA Hymnal MUST be brought to camp

FEES

Campers aged 15 years and above - $35.00
Campers between 5 and 14 years - $20.00
Campers between 0 and 4 years old – $5.00