Eko-French Language Camp in Canada

Registration Form 2009
Please complete form and return it by fax or mail with one pass photo to
Aimco Services
51-165 Chandos Dr. Kitchener, ON  Canada  N2A 4A2
Fax:  519-895-2912
E-mail:  eko@aimco-services.com
(Do not send payment.  We will bill you)

All sessions begin on Fridays from the end on June to the end of August.
Minimum three-week stay required.
Starting June 26, 2009 and thereafter every Friday   

Last day of camp: August 28, 2007

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 _________________________________________________________

Camper's family name:______________________________________________________________

Camper's first name:   _______________________________________________________________

Sex:   Male ___   Female ___

Date of birth: (day/month/year) ________________________________________________________

Nationality: _______________________________________________________________________


Parent/Guardian responsible for the child's stay at Ekocamp

Family name: _____________________________________________________________________
  
First Name:_______________________________________________________________________

Postal address: ___________________________________________________________________

City:  ______________________  State/Province: _________________

Zip code:________   Country: _________________

Home telephone: ___________________________ Office: ________________________

Cellular telephone: __________________________  Fax: _________________________

Previous camping experience (any camp) & how many weeks camp experience:

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In which language would you like us to communicate:
___

Do you intend to drive your child to camp?   Yes ___      No ___

Do you intend to pick up your child from camp?  Yes ___  No ___  Yes ___  No ___

Does participant require airport transfer from and to Montreal   Yes ___        No ___

Which optional activity?:     Rafting ___    Visit Montreal ___    Visit Ottawa__     Visit Quebec City ___

Number of weeks of Emergency Medical and Hospital Insurance? Weeks ____ No ____

How will you pay (please check):    Credit card online (Secure site) ___
Credit card payment by fax ___      Bank transfer ___

Cancellation

In the event that you wish to cancel the registration of your child at Ekocamp, simply let us know in writing. Ekocamp will refund the total amount paid, less the sum of $ 250 Canadian for administration. Ekocamp must receive cancellation six weeks prior to the start of your child’s stay at the camp.

Comments:


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Please complete form and return it by fax or mail with one pass photo to
Aimco Services
51-165 Chandos Dr. Kitchener, ON  Canada  N2A 4A2
Tel:  519-895-2880
Fax:  519-895-2912
E-mail:  eko@aimco-services.com
(Do not send payment.  We will bill you)