Spark- Brownies Provincial Camp 2016
Application Form
June 17-19, 2016 Gitten’s Lodge (Truro)
Drop off: 7:00 pm Friday, Pick up 11:30 am Sunday
Theme: Princess Palooza
Deadline for Application to Arrive at Guide House: April 22, 2016. Please complete ENTIRE APPLICATION and HEALTH FORM and submit with payment.
Name ______Membership #______
Address ______
Telephone: Home ______Other______
Date of Birth (YYYY/MM/DD)______
Age as of January 1, 2016______
Spark or Brownie Level as of January 1, 2016 (circle) Spark Brownie 1st year 2nd year
Email______
Spark/Brownie Unit ______District/Area ______
Contact Guider / Leaders Name______
Have you attended a Camp before? (circle) Yes No
Number of nights: in tents ______buildings______Would you like to sleep in a tent at this camp? YES NO
Have you attended a Spark Brownie Camp before? (circle) Yes No
How often do you spend nights away from home? (Camps, time with friends etc.) (circle)
Often Not very often Never
By signing this application I (we) understand that all applications will be subject to lottery process and submission of this application, or cheque cashing of camp fee, does not guarantee acceptance to Spark Brownie Camp 2016.
Date ______Camper Signature______Parent/Guardian Signature______
THE FOLLOWING ITEMS MUST BE INCLUDED WITH THIS APPLICATION FORM. NO POST DATED CHEQUES. GIRL GUIDES OF CANADA, NS COUNCIL WILL CHARGE A $20 FEE for NON-SUFFICIENT FUNDS (NSF CHEQUES). REFUNDS WILL BE GIVEN ONLY IF REQUESTED IN WRITING 1 WEEK IN ADVANCE OF THE EVENT
1) Completed Health Form (H1)
2) Camp Fee $65 ($56.52 + 8.48 HST)
SUBMIT TO: Girl Guides of Canada: Attention Spark Brownie Camp 3581 Dutch Village Rd Halifax, NS B3N 2S9
"We protect and respect your privacy. Your personal information is used only for the purposes stated on or indicated by the form. For complete details, see our Privacy Statement at www.girlguides.ca or contact your provincial/territorial
office or the national office for a copy."
FOR OFFICE USE ONLY:
IMIS # O IMAGE RELEASE O REGISTERED MEMBER