Religious Affiliation (if any)
Attended GLC before?
Parent(s)/ Guardian(s) Names
Main Phone #
Other Phone #
Choice of Camp and Choice of Rates
Choices of Weeks and Dates
Junior 1 July 5 - 11
Junior 2 July 19 - 25
Junior 3 August 9 - 15
Junior Outdoor Adventure Camp 1 - July 12 - 18
Junior Outdoor Adventure Camp 2 - August 2 - 8
Scamper Camp (SC) July 26 - 28
Intermediate 1 July 12 - 18
Intermediate 2 August 2 - 8
Intermediate Outdoor Adventure Camp 1 - July 5 - 11
Intermediate Outdoor Adventure Camp 2 - Aug 8-15
Youth Outdoor Skills (YOSC) Camp - July 19 - 28
Senior Youth August 16-22
Rate you will pay (click question mark for details)
$420 (All week-long camps--1st week/ 1st camper)
$360 (All week-long camps--2nd week/ 2nd camper)
$265 (Scamper Camp--3 days--1st 3 days/ 1st camper)
$225 (Scamper Camp--3 days--2nd 3 days/ 2nd camper)
$560 (Youth Outdoor Skills--1st 10 days/ 1st camper)
$465 (Youth Outdoor Skills--2nd 10 days/ 2nd camper)
Requesting Geared-to-Income (further down on form)
Like to donate to our Camper Subsidy Fund? (Tax receipt available)
Yes, I would like to donate.
Sorry--not this year.
I don't know much about it (click the question mark)
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.)
Other serious medical issues
Mental health issues
Please contact us for details
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.
Family/ friends/ my child's friends
Summer camp website www.ottawacamps.com
My child's school
Social media (Facebook, Twitter, Instagram, etc,)
On the radio
Our camp's website (www.goldenlakecamp.ca)
Our local church
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?
I will submit the full amount
I will submit a $50 deposit
I am applying under "Geared-to-Income"
NOTE: If you choose to only
$50 deposit, we will
the outstanding balance
in the two weeks
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 firstname.lastname@example.org.
Which of the following best describes your family's situation?
We are on Ontario Works or ODSP
Employed but family's income under $25,00 a year
Income above $25,000/year, but under financial stress
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.