RAINBOWS Camp Application Form
      July 22 to July 27 or Aug 3 - 8, 2012

Guest Registration Information:
Attending Parent

Child Age Grade (Sep 2012)      .

Child     Age Grade (Sep 2012)       .

Child  Age  Grade (Sep 2012)        .

Home Phone Email                                                                       .

Street Address .

City  Prov  Postal Code                 .

I have attended a RAINBOWS or DivorceCare program:  Yes      No
If Yes,  (where)  (when)                                       .
 Fees:   Parent $250.00 plus $30 per child (6 days / 5 nights)  
The fees shown have been heavily subsidized to keep them as low as possible.

Dates Attending                                                                          .

Payment in the amount of $  (Please do not send cash in the mail)

Cheque    Money Order    Visa    Mastercard

Card Number Exp. Date

Signature Date 

Fees paid by other (specify) 

Make Cheques payable to Pine Lake Christian Camp
Fax form to:    (403) 286-4003

or Mail form to:  Linda Anderson – Rainbows Camp Dean
Bow Valley Christian Church

5300 53 Ave NW  Calgary, Alberta T3A 2G8