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
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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
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