/ Camp Samac – Program Booking Form 2012
For Categories A & B – All youth groups
E-Mail address:

Category

q Scouts Canada / q Girl Guides of Canada / q Other Youth Groups / Total # attendees:
Group Name / Section

Arrival/Departure Information:

Arrival Date (dd/mm/yy): / Time:
Departure Date (dd/mm/yy): / Time:
Individual In Charge (On site while at Camp):
Name: / Cell Phone
Position in SC/GGC: / Home Phone
E-mail / Work Phone
Individual Making Reservation:
Name: / Phone
E-mail
A: Range – rates are for a 3 hour session / WPC Scout
Groups / Other
Scouts-Guides / Other Youth Groups
q Archery – 8 yrs & older / Date: / Time: / $30 / $40 / $60
q Additional Time (extra Range Time @ $10/hr) / No. of hours:
q Pellets – 11 yrs & older
Includes 1 tin of 500 pellets / Date: / Time: / $45 / $55 / $90
q Additional Time (extra Range Time @ $15/hr) / No. of hours:
q Additional Pellets (Tins of 500 pellets each @ $10/ea.) / No. of tins:
q 22s – 14 yrs & older / Program not available at this time.
Unless otherwise specified a volunteer Range Line Safety Officer (R.L.S.O.) will be assigned to run the Range for your Group. The R.L.S.O. will open the Range, provide basic instruction and coaching and run a safe Range for you. If you have a currently Certified R.L.S.O. already available to you (e.g. a member of your Group), please note the individual’s name below.
q Yes, we have an R.L.S.O. who will run the Range for us / R.L.S.O.’s Name
q No, we do not have an R.L.S.O. and will require one to run our Range.
Assigned R.L.S.O.
B: Canoes/Snowshoes
q # Canoes: ______/ Date: / Time: / Fee: $10 per canoe per day
10 canoes available at Samac
15 canoes at Adventure Base
q Snowshoes:
# Adult: ______
# Youth: ______/ Date: / Time: / Fee: $10 per day per pair
15 Adult, 5 Youth pairs
Pick-up from Ranger’s office
C: Program Supplies – rates are for a 4 hour session
Pick up supplies from Warden/Ranger on duty / Morning
9:00 – 1:00 / Afternoon
1:00 – 5:00 / Evening
6:00 – 10:00
q Lashing / $5
q Ropes and Knots / $5
q Bingo - Bugs / $5
q Bingo - Word / $5
q Bingo - Nature / $5
q Scavenger Hunt / $5
q Naturalist Badge (Scouts) / $5
q Tug of War Ropes 108 foot length #1q #2 q
50 foot length #1q #2 q / $5 each
D: Group Activity Areas (as an introductory offer there currently is no charge for these programs)
q Obstacle Course – in Rec Field / Date:
q Team Challenge Course – South Lakeland
See Warden/Ranger for equipment / Date:
q Human Size Chess Board – Council Hall
See Warden/Ranger for game instructions / Date:

E: Deposit and Final Payment – 10% deposit required, balance due 30 days prior to arrival date

q Cheque Cheque #: ______Bank: ______

q Credit Card Type (MC/Visa): ______CC #: ______

Expiry Date–Month/Year: _____ Signature: ______

**********

The deposit MUST accompany your booking in order to secure reservation.
Booking is secured once you receive confirmation from the Camp Administrator.

Return to: Scouts Canada, WPC Camp Administrator, 1711 Simcoe Street, Oshawa, ON L1G 4Y1
email: Fax: 1-905-571-7920

Billing Information (To be completed by Office)

Programs Reserved / Cost / Method of Payment
Program 1
Program 2 / Cheque / Cheque #:
Program 3 / Credit Card / Type (MC or Visa):
Extras / Credit Card #:
Extras / Expiry Date - Month/Year:
SUBTOTAL A =
(Payment Method – if by Credit Card) 2%
SUBTOTAL B = / Amount / Date Paid
13% HST / 1st Payment
TOTAL = / 2nd Payment

Phone: 1-905-571-1346 Ext 23 Fax: 1-905-571-7920 E-mail: Revised September 2012

Samac-annual-bookings-forms