Registration Form for Summer 2019

Camper Information

First Name
Last Name
Age @ Start of Session
Date of Birth (dd / mm / yyyy)
/ /
Number of years at Ak-O-Mak
Tee Shirt Size
Home Address: Street
City
Province / State
Country
Postal / Zip Code

PARENT / GUARDIAN 1 NAME:

Home Phone
Cell Phone
E-mail

PARENT / GUARDIAN 2 NAME:

Home Phone
Cell Phone
E-mail

SESSION INFORMATION

(All fees in Canadian Dollars)
Session 1 Session 2 Session 3 Session 4 Session 5 Session 6
Session Length: 7 Weeks 4 Weeks 2 Weeks 3 Weeks 2 Weeks 2 Weeks
2019 Dates: Jun 26-Aug 14 Jun 26-Jul 23 Jun 26-Jul 10 Jul 24-Aug 14 Jul 24-Aug 7 Aug 17-Aug 31
Please Check a Session:
Base Tuition: $6,230.00 $3,900.00 $1,990.00 $2,925.00 $1,990.00 $1,900.00
13% Harmonized Tax: $809.90 $507.00 $258.70 $380.25 $258.70 $247.00
Refundable Expense Account: $350.00 $150.00 $100.00 $150.00 $100.00 $75.00
Included Activities
Ottawa Paddling
Regatta/Shopping:
$400.00 $400.00
Barrie Triathlon: $275.00 $275.00
TOTAL: $8,064.90 $4,957.00 $2,348.70 $3,730.25 $2,348.70 $2,222.00
Medical Insurance Non CDN: $200.00 $110.00 $60.00 $90.00 $60.00 $60.00
Non Canadian Total: $8,364.90 $5,267.00 $2,408.70 $3,920.25 $2,408.70 $2,307.00
EARLY BIRD SPECIALS: Non Canadians Add Medical Insurance to Early Bird Special.
October 31st, 2018 Special: $7,008.92 $4,295.95 $2,011.40 $3,234.46 $2,011.40 $1,899.95
December 31st, 2018 Special: $7,360.91 $4,516.30 $2,123.83 $3,399.73 $2,123.83 $2,007.30
January 31st, 2019 Special: $7,712.91 $4,736.65 $2,236.27 $3,564.99 $2,236.27 $2,114.65
$500.00 Deposit due upon registration (non-refundable). Balance due four weeks prior to start of Session and/or on June 1st, 2019.

Payment Information

October 31st Special
Must be paid in Full: $
December 31st Special
Must be paid in Full: $
January 31st Special
Must be paid in Full: $
Deposit Only: $500.00
Balance June 1st:
Payment Plan $500.00 a month ($500.00 Payment will be taken the 1st of the month, Full/Balance of payment is due on the 1st of June 2019):
Must have a valid credit card on file.
Payment Method:
Card Number
Name on Card
Expiration Date (mm/yy)
CVV (Back of Card)
Campers Name:
Session Attending:
Please consider giving to Camp Ak-O-Mak for Girls Non Profit Fund Raising, I wish to contribute: $
A receipt will be issued for any donations to Camp Ak-O-Mak for Girls Non Profit.

I Confirm that the payment details above are correct.

The $500.00 reservation deposit, full payment or partial payment required for each session can be paid by Cheque, Visa, MasterCard or Wire Transfer. I authorize Camp Ak-O-Mak to use the above credit card for the tuition, tuition balance, partial payment and for the reconciliation of my camper`s expense account. Early discounts apply if paid in full by October 31st, 2018 or December 31st, 2018 or January 31st, 2019.

TERMS AND CONDITIONS

  • Early discount applies if Paid In Full by October 31, 2018 or December 31, 2018 or January 31st. 2019
  • You will receive email acknowledgement within 48 hours of receipt of Registration form.
  • A valid credit card is required to reconcile charges in excess of refundable expense account which may include elective events / activities, associated travel / food, medical expenses, camp store; Airport travel, Rentals and extra items if used.
  • Final processing of the Refundable Expense Account will be completed after camp and a statement of accounting emailed to the parent. Please ensure email address is current .
  • Refund Policy: Refund (less $500.00 non-refundable deposit) for cancellation by May 15th. Full refund may be available only for a medial reason with a doctor's note or registration may be transferred to next season.
  • I agree Camp Ak-O-Mak is released from liability in connection with medical treatment and unavoidable accidents. Camp Ak-O-Mak has my permission to use necessary medical measures in the event of an emergency. My child has permission to leave the campgrounds with authorized camp staff for scheduled trips and outings.

I Agree

Parent / Guardian First Name
Parent / Guardian Last Name
Today's Date

HOW DID YOU HEAR ABOUT Camp Ak-O-Mak?

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which publication/website?

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

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