E Camp Registration August 29 - 31, 2015 Name: email: phone number: mailing address: Camp Fees: # of adults (age 18+) x $60 = $ # of children (age 3 - 17) x $40 = $ Subtotal = $ Accommodation Fees for 2 nights: For information about the various accommodation options, visit www.ECFAvictoria.ca/e-camp The lodge rooms will be reserved in the order that registrations are received. Branter Lodge (2 beds/room) $70/room $ Laura Butler Lodge - large room (6 beds/room) $200/room sharing with: our portion of the fee: $ Laura Butler Lodge - small room (2 beds/room) $70/room Cabin (12 beds) $240/cabin sharing with: $ our portion of the fee: $ Tent (bring your own) $40/tent $ Other: $ Camp Fees Subtotal + Accommodation + $10 ECFA membership (optional)= $ My family cannot afford the full registration fee. We can afford: Dietary Requirements: (requests will be honoured if received by August 14) Number of family members requesting: vegetarian meals gluten-free meals dairy-free meals Page 1 of 2 E Camp Registration August 29 - 31, 2015 Release of Liability By registering my family to participate in E CAMP 2015, I, for myself, my heirs, executors, administrators and assigns, waive any claims to which I and/or my children may become entitled for injury or damage and release the ETHIOPIAN-CANADIAN FAMILIES ASSOCIATION (ECFA) from any claims for damages or injury suffered by me and/or my children as a result of our participation in or traveling to or from this event. I further state that my children and I are in proper physical condition to participate in this event and I am aware that participation could, in some circumstances, result in physical injury. I also give my permission for the free use of a group picture by the ECFA. Mother's Name: Mother's Signature: Date: Father's Name: Father's Signature: Date: Children participating in this event: Name Age Name 1 5 2 6 3 7 4 8 Age In the case that your registration includes adults only, complete the following instead: Name Signature Date 1 2 Emergency Contact Name: Phone Number: Please send: 1. Registration Form (2 pages), completed and signed 2. Cheque payable to ECFA (or email money transfer to [email protected]) to: ECFA, 61 Regina Ave, Victoria BC, V8Z 1H8 Page 2 of 2
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