RADIATE 2022 REGISTRATION

We are excited to welcome your church to camp for one of our Radiate weekends.

Thank you for taking the time to complete our online registration form.

If you have any questions about the registration process please feel free to contact Laurie Robb at lrobb@pioneercamp.ca

Step One: Registration & Deposit

Once you have submitted this online registration form, you will receive a confirmation email with more details confirming your registrations, submitting final numbers as well as arrival details.

A deposit method must be chosen on this form - deposits can be paid either by credit card or by cheque.

An estimate of your group size - broken into leaders and students by gender will also be required to complete this form.

Step Two: Final Confirmation

Your group will be required to submit a Group Confirmation Form on the Wednesday before the retreat which must include the exact numbers of male and female students and leaders plus dietary, and other special requests. A link to this form will be emailed to you closer to your arrival at camp. The final payment will be required no later than one week after your visit to camp.

Group Leader Name *

Church Name *

Street Address *

Address Line 2

City *

Province *

Postal Code *

Cell Number *

Church Phone Number *

Email Address *

Which Radiate will you be attending? *

Radiate 1 - April 1 - 3

Radiate 2 - April 8 - 10

Radiate 3 - May 6 - 8

Is this your first time attending a Pioneer Camp program? *

Yes

How did you hear about Radiate? *

Your church must provide a certificate of insurance to Pioneer Camp before your arrival. If you are unable to provide a certificate of insurance, each student and leader will be required to fill out a Pioneer Camp waiver form. If your church is able to provide the certificate of insurance then no waivers are required.

Our church will provide: *

Certificate of Insurance (emailed to lrobb@pioneercamp.ca before arrival at camp)

Signed waivers from all leader and student participants (these will be emailed to the group leader before arrival at camp)

Number of Female Adult Leaders *

Number of Female Students *

Number of Male Adult Leaders *

Number of Male Students *

Total Group Size *

We require a male leader to accompany any male students and a female leader to accompany any female students. The recommended ratio is 5:1 and the minimum ratio is 10:1. All leaders must have been appropriately cleared through your church's child protection policy. By signing below you are acknowledging your compliance.

Signature *

clear

Payment/Liability Credit Card Information (required for damages even if paying by cheque)

Name on Card *

Street Address *

Address Line 2

City *

Province *

Postal Code *

Phone Number *

Email Address *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

CVD *

Radiate Pricing: 138.00 + HST per person. A non-refundable deposit of $50.00 per person (including leaders) is required to guarantee your spots when registering. How would you like to pay your deposit and final bill? *

Use this credit card for deposit and final payment

Deposit and final payment will be paid by cheque mailed to the camp office at 942 Clearwater Lake Rd Port Sydney, ON P0B 1L0

Deposit and payment will be paid by etransfer to: pioneerontarioeft@pioneercamp.ca. Please indicate your church name in the transfer message.