Father/Son Fishing Camp
May 17 - 20, 2013

Name:   
Address: 
City:  Province: 
Postal Code: 
Email: 
Phone Number - Home:  Work: 
Health Card #:  Province: 

Emergency Contact Information
Names: 
Relation:  Emergency Numbers - 1: 2: 
Does the Camper have any physical, emotional, allergic, dietary or behavioural problems? Yes   No
If yes, please explain:

Please Note: We cannot guarantee a peanut-free camp.

I / We have read and hereby agree with the waivers and conditions of this camp.
Agree  Disagree

For registrants under 18 years of age, please have parents or guardian contact Stephen Gibbard.

Church Affiliation
Name:   
Address: 
City:  Province: 
I'm interested in:
Helping at a Nemeiben Work Camp
Receiving information about Winter Camps
Canoe Trips
Family Camps
Counselling / Support Work at Nemeiben's Children Camps
Providing financial assistance, one time gift or monthly
Comments: