Camper Information

First Name *

Last Name *

Birthdate * +

Age *

Gender *

Street Address *

Town/ City *

Prov *

Postal Code *

Religious Affiliation (if any) *

Attended GLC before? *

Parent(s)/ Guardian(s) Names *

Parent(s)' Email 🛈

Main Phone # *

Other Phone #

Emergency Contact *

Phone # *

Choice of Camp and Choice of Rates

Choices of Weeks and Dates * 🛈

Rate you will pay (click question mark for details) * 🛈

Like to donate to our Camper Subsidy Fund? (Tax receipt available) * 🛈

If you choose to make a donation, please select amount:

Need a Receipt for Tax Purposes? * 🛈

Other Helpful Information

Does this camper have any serious allergies/ medical conditions/ mental health issues/ behavioural issues? (You will receive a detailed health form later.) *

Details you would like us to know:

Also Inviting a friend? (If so, check out the "Friends at Camp" form on the website's registration page)

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

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

Paying for your child's attendance

How do you plan to pay? *

NOTE: for payment choices other than a credit card,

please scroll to the bottom of this form.

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

NOTE: If you choose to only

send the $50 deposit, we will

process the outstanding balance

in the two weeks preceding the

camp your child is attending.

Total amount you plan to submit: * 🛈

Payment using a credit card

Name on Card

Credit Card Type

Credit Card Number

CVV # (on back side of card)

Expiration Date (mm/yy)

Complete the following section only if you are requesting "Geared to Income" or an "Extended-Payment" plan. Otherwise proceed to the last green section (below).

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?

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

If you are paying by credit card, or requesting "Geared-to-Income," you are almost done! Just click "Submit". If you are paying by e-transfer or by cheque, click "Submit" and then return to our website for further instructions.