Pioneer Camp Registration

Your Name *

Email Address

Phone Number (please give a number that can also be used as an emergency contact number) *

Child’s Name *

Age *

Please let us know if there are any medical or physical restrictions we should be aware of (allergies, asthma, etc)

I would like to register my child for: *

Full Week – August 6 -August 10

These days only:

Days:

Add second child

Yes

Child 2: Name

Child 2: Age

Child 2: Medical or physical restrictions

Child 2: I would like to register my child for:

Full Week – August 5 – August 9

These days only:

Child 2 Days:

I hereby give my full consent and approval for my child to participate in the activities of this Camp.

I acknowledge that certain RISKS OF INJURY are inherent to participating in these activities.

I hereby waive, release and hold harmless the Creston & District Historical & Museum Society, its officers, staff, and volunteers for any injury that may be suffered by my child in the normal course of participation in the activities.

I agree

Name

First

Last

Date

If you are human, leave this field blank.

Thank you for registering! We will send you an invoice shortly – you can pay online via credit card or in person with cash or cheque any time up to the start of the camp.