SALT 2015
Summer Adventure Leadership
Team
Presents …
Open to children in Junior Kindergarten to Grade 6
Registration Form
Child’s Information
Child’s Name: ___________________________________________
Address: ________________________________________________
SECRET AGENT:
________________________________________________
Birthdate: _____________________
Gender:
M
F
Grade in September 2015: __________________________________
Church Affiliation (if any): ________________________________
Parent/Guardian Contact Information
Name: __________________________________________________
Home #: ________________________________________________
Work/Cell #: _____________________________________________
Email Address: ___________________________________________
God’s mission for us
Emergency Contact Information
Name: __________________________________________________
Home #: _________________________________________________
Work/Cell #: _____________________________________________
Colborne Street United Church
August 10 - 14, 2015
I give permission for photographs of my child to be taken for:
Facebook
Websites
None
Promotional use for Colborne or the community
Colborne Street United Church
and the SALT Team …
Camper’s Health Information
Allergies (food or other): _____________________________________
__________________________________________________________
Invite you to further explore all of your special gifts and abilities,
which were given to you by God, and learn more about how these gifts
__________________________________________________________
can help you in your mission! God has a special mission for all of us…
Physical or Mobility Concerns: ________________________________
how will your special skills help you with your mission for the world?
__________________________________________________________
Campers will explore their faith with the help of enthusiastic
__________________________________________________________
counsellors, and will surely have a fun filled week full of adventures
with the Summer Adventure Leadership Team 
Medication camper will be required to take while at camp, if so what:
Camp Times:
__________________________________________________________
__________________________________________________________
Other related health information we should be aware of: ____________
Monday – Thursday 9:00am - 4:00pm
Friday 9:00am - 2:00pm
__________________________________________________________
Friday @ 1:30pm  Parents/guardians are invited to attend a
presentation put on by the campers
__________________________________________________________
**Remember to bring a nut free lunch … snacks will be provided**
Swimming Ability: _________________________________________
Cost:
$85 per child or $215 per family (of 3 or more children)
(Subsidy available upon request,
please contact the church office)
Please send a cheque with your registration form to reserve your spot by June 1st. To
cancel your registration and be eligible for a refund Colborne must receive notice by June
30th.
Please send to:
Please Return to Colborne Street United Church
Colborne Street United Church
711 Colborne Street
London, Ontario
N6C 2A5
Email Contact: [email protected]