Adult Camp Registration Form 2019

Camper Information

Camp Dates: Wednesday June 12th to Monday June 17th, 2019

Price: $1,100.00 + 13% Tax, Total $1,243.00 (Canadian)

Inclusive food & accommodation

First Name
Last Name
Home Address: Street
Province / State
Postal / Zip Code
Home Phone
Cell Phone
Male Female

Payment Information

Payment Method:
Deposit Amount: $250.00 Balance Due May 15th, 2019: $993.00
Early Bird Special Must be Paid in Full by January 31st, 2019: $1,118.70
Card Number
Expiration Date (mm/yy)
CVV (Back of Card)
Name on Card

I authorize Camp Ak-O-Mak to use the above credit card for the tuition & any reconciliation of my account.


  • Deposit of $250.00 is required upon Registration. Final payment is due on or before May 15th, 2019
  • The Balance will be charged to the same card as the deposit unless you inform us otherwise.
  • Refund Policy: Refund (less $250.00 non-refundable deposit) for cancellation by May 15th, 2019
  • All credit card transactions are final sales that cannot be disputed or be subject to a charge back.
  • I agree Camp Ak-O-Mak for Girls is released from liability in connection with medical treatment and unavoidable accidents. Camp Ak-O-Mak for Girls has my permission to use necessary medical measures in the event of an emergency.
  • Liability Release Waiver is required to be signed in advance or upon Check-In.
  • I agree and accept that the proper forum for ANY legal action against Camp Ak-O-Mak for Girls or it’s associated personnel, including Medical, is the Province of Ontario, Dominion of Canada.

Business Office: 14-441 Stonehenge Drive, Ancaster, Ontario, Canada L9K 0B1,
Tel.: 416.427.3171, Fax: 905.304.2982
Email: Website:

Summer Address: 240 Akomak Road, Ahmic Harbour, Ontario, Canada P0A 1A0,
Tel.: 705.387.3810, Fax: 705.387.0077