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2016 Copper Island
Summer Youth
Camps
DATES
Elementary Camp
Ages: 9-11 July 5-9
Middle School Camp
Ages 12-14 July 12-16
High School Camps:
(Space Limited - Please Call)
Young Women’s Specialty Camp
Ages 15-18 July 19-23
Young Men’s Adventure Camp
Ages 15-18 July 26-30
Phone: (778) 421-4883 or
(250) 720–1798
Canoes
Kayaks
Swimming
Friendships
Bible Stories
Hiking
Singing
Great Food
Crafts
Games
And lots more!
Wilderness
Dear Parent or Guardian,
Copper Island Camp is a place where your child can
have the fun of a summer camp. He or she will learn
moral and spiritual lessons from the Bible in the class-
room of our wilderness. Each one will have a role mod-
el who is individually selected and screened to give
your child one of the best weeks of his or her summer.
Copper Island Camp may well be the best five days
invested in your child’s summer.
Supporting families by enriching young lives ~
Copper Island Camp
WHAT TO BRING TO CAMP:
Bible
Sleeping Bag
Pillow
Comfortable clothes for
the outdoors and all
types of weather
Shoes for trail walk-
ing/hiking
Warm Jacket
PLEASE: no iPods, mp3 players, cd players, radios,
cell phones, electronic games, or hair dryers.
2016 Copper Island Camp Registration Form
Parent or Guardian: Please print,
fill out completely and sign.
Student’s Name:
____________________________________________
Birthdate: ______________ Male Female Parent(s) or Guardian(s) Name:
____________________________________________
Street Address:
____________________________________________ City:______________________ Province: _____
Postal Code:_________________________________
Contact Phone number: (_____) ________________
Who plans to pick your child up after camp? ____________________________________________ Family Doctor:_______________________________
Doctor’s Phone #:___________________________
Care Card #:_________________________________
Allergic Reactions:
Bee Stings_______________________________
Food___________________________________
Other__________________________________
Medication (include dosage & purpose) to be taken
regularly at Copper Island: ____________________
___________________________________________
Is there anything else we should be aware of regard-
ing your child?______________________________
___________________________________________
Rain Jacket
Towels for shower
and beach
Swimsuit
Personal Toiletries
Flashlight/Batteries
Bug Spray
Fishing gear
(optional)
We will meet at the Lady Rose Marine Services dock at
Harbour Quay at 7:30AM on Tuesday mornings.
Please pick-up your child Saturday, the last day of the
camp, at the Lady Rose Marine Services dock at 5:00PM.
Registration due by:_____________________
Please mail form to: Copper Island Camp
2775 9th Avenue
Port Alberni, BC V9Y 2M6
Phone: (778) 421-4883 or (250) 720-1798 or (250) 724-9989
Or give form to:______________________
Please select session attending:
Elementary Camp Fee: C$160.00
July 5-9, 2016 (ages 9-11)
Middle School Camp Fee: C$160.00
July 12-16, 2016 (ages 12-14)
Young Women’s High School Camp Fee: C$170.00
July 19-23, 2016 (ages 15-18)
Young Men’s High School Camp Fee: C$170.00
July 26-30, 2016 (ages 15-18)
Total Payment Enclosed: $_______________
In case of medical emergency or general medical care, I give consent for medical treatment by authorized personnel for my child named above. While every effort is taken for the safety and good health of our guests/students and because of the intrinsic dangers of wilderness experiences, Copper Island Camp / The Wilderness Retreat Society, its board, directors, employees, and volunteers are released from any liability in the event of an illness, accident, or trauma that may occur to one of our guests/students. The Director of Copper Island Camp reserves the right to dismiss any guest/ student who in his opinion is a hazard to the safety of others or who appears to have rejected the reasonable objectives and guidelines of Copper Island Camp. I certify the above child has my permission to attend Copper Island Camp and participate in all activities. I also realize that my child’s picture or shared stories of their time at Copper Island may be used in the promotion of the camp.
Signature of Parent or Guardian:
_______________________________________
Date:__________________________________
created for a purpose