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CNIB LAKE JOSEPH CENTRE

By Shane Ray,2014-06-28 12:03
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CNIB LAKE JOSEPH CENTRE ...

Lake Joseph Centre

2009 Family Registration Package

To secure your spot, please complete and return the following

    application package, including all necessary forms and appropriate

    payments to Lake Jo, MacTier (address listed at the end of the

    registration package).

Forms to be returned with your application include:

Section 1 Required

    Registration form (camper information, etc.)

    Signed CNIB Lake Joseph Centre policies

Section 2 Required

    Signed waiver of claim and release

    Completed 2009 health and dietary information form (Note: If you are

    receiving ongoing care, this form will need to be updated four weeks

    prior to your arrival at camp)

    Signed CNIB Lake Joseph Centre Code of Conduct

Section 3 Required

    Payment and confirmation information

    Deposit payment ($200 minimum per week of attendance)

Section 1

Registration Form

Must be completed by all guests including Guides and Intervenors.

    First name: Last name: Address: City:

    Province: Postal Code: Telephone (day):

    (evening): Email Address:

    Age:

     Male Female

    First name: Last name: Age:

     Male Female

    First name: Last name: Age:

     Male Female

    First name: Last name: Age:

     Male Female

    First name: Last name: Age:

     Male Female

Please check one of the following. Are you attending camp as a:

     Client Family Member

     Intervenor, for: Guide, for:

Please indicate the family member(s) that is/are the CNIB client(s):

     Please answer the following questions.

1. Are you a caregiver completing this application on behalf of a client?

     Yes No

2. Will you be attending camp with the client?

     Yes No

NOTE: Caregivers attending must submit their own application and

    payment.

Caregiver Contact Information

First name:

    Last name:

    Telephone (day): (evening):

    Email address:

Please indicate your choice for desired vacation period(s) and related

    activities.

Adult Sessions

    $500 based on double occupancy for a family of two

    $900 based on double occupancy for a family of three or four

    Additional immediate family members are$225, additional friends and

    extended family members are $600 each camper.

    2 p.m. check-in and 10 a.m. check-out

     Fun for the Family: Sunday, July 19 Saturday, July 25

     Family Adventure Week: Sunday, August 2 Saturday, August 8

Please check off programs you are interested in and your skill level:

     Waterskiing: (Under 18)

     Beginner Novice Intermediate

     Cycling: (All Campers)

     Beginner Novice Intermediate

     Sailing: (Under 18)

     Beginner Novice Intermediate

     Instructional Swimming: (Under 18)

     Beginner Novice Intermediate Please indicate last level complete: *Lake Jo will do its best to accommodate each of the selected activities for all

    families, however, we cannot guarantee access to all activities for all families.

All prices are based on double occupancy. Campers have the option to

    request a roommate of choice. Campers may also request for a single

    room. The cost for a single occupancy room is the full cost of the room,

    $1,200. Single occupancy is based on availability. Lake Jo will do our

    best to accommodate each individual camper request. Note: Pets are

    not permitted at camp, service dogs only.

Please answer the following questions regarding rooming.

Will you or someone in the family be bringing a guide dog?

     Yes No

Are you or someone in your family deafblind?

     Yes No

Do you or someone in your family require a wheelchair accessible

    washroom?

     Yes No

Please list any people you would like to have as a roommate

    1

    st choice: nd2 choice:

    Please list any people you would not like to have as a roommate st1 choice: nd2 choice:

If you are coming as part of a group, please state the name of your

    group or group contact:

    **Lake Jo will endeavour to accommodate all rooming requests from our guests. However, due to demand not all requests can be guaranteed.

Transportation

    Lake Jo is happy to offer transportation to and from the camp for campers. Please fill in the form below should you wish to use this service.

    Pick up

     Toronto (Yorkdale Mall)

     Sudbury (Highway 17 Canadian Tire)

    Drop off

     Toronto (Yorkdale Mall)

     Sudbury (Highway 17 Canadian Tire)

Roundtrip Cost

    Family of two: $75

    Family of three or four: $130

    Each additional person is $50

CNIB Lake Joseph Centre Policies

    (Please read and sign declaration)

    All guests attending camp must complete and submit this form. This includes all CNIB clients, intervenors, guides and family members.

No Smoking, Alcohol or Drugs

    These sessions at camp are no smoking and no drinking sessions. Any camper caught participating in any activities relating to smoking or alcohol consumption will be sent home at the expense of the camper. Adults can smoke and consume alcohol during their stay at camp, but in designated areas only.

Payment Policy

    To reserve a space at Lake Jo, a minimum deposit of $200 per week must be received with your application. Do not send post dated deposit cheques reservations will not be processed until the date of payment,

    not the date the cheque was received.

    Balances must be paid in full by June 1, 2009, or camper registration will be cancelled. All appropriate cancellation fees will apply.

    Early Bird gift: If all camper fees are paid in full before April 1, 2009, you will receive a special gift when you arrive for your stay at Lake Jo.

    A monthly payment plan is now available. By sending in post dated cheques (after the payment of the initial deposit) or credit card information along with your application package, equal monthly payments can be withdrawn from your account. Once your information is processed at Lake Jo, you will receive a confirmation letter indicating the amount of your monthly payments.

Cancellation Policy

    Cancellations made more than 60 days prior to the start of your vacation date, will be subject to a $25 administration fee (including medical reasons).

    Cancellations made less than 60 days prior to the start of your vacation date, will be subject to the loss of your entire $200 deposit (including medical reasons).

Changes to your Vacation Week

    A minimum two weeks notice is required to change your vacation week. The change is subject to availability. Guests are permitted to change their vacation week only one time (Medical reason is the only exception. Proof of illness will be required for additional changes).

Group Registration

    Lake Jo will do our best to place the members of the same group in the same cabin. Below are some tips for the group registration process.

    Assign one member of the group to collect all completed forms and

    payments, and submit them in one package

    Include a rooming list in your group package Once we receive all completed forms and payments, spaces will be reserved. All application rules and deadlines apply to groups and all group members.

Financial Assistance

    All guests are welcome to apply for additional assistance. The application does not guarantee funding or funding amounts. If you are

    interested in receiving additional funding, please complete Section 2 and include all required documentation.

Swim Tests and Waterfront Safety

    Any camper wishing to participate in any waterfront programming (including boating) must participate in a swim test. Swim tests are traditionally offered on arrival day. It is the discretion of the CNIB Lake Joseph Center Lifeguards and Waterfront Coordinator to assess the swimming ability of each camper.

    According to the Lifesaving Society, children seven years and younger must be within arms reach of an adult in the water (someone 16 years or older) as well as on the beach. This is in addition to the Lifeguards on the beach. Families are responsible for providing this supervision. For more information , please visit www.lifesavingsociety.ca.

    Campers aged eight to 12 must be accompanied to the beach and waterfront by an adult (someone 16 years or older). This is in addition to the lifeguards on the beach. Families are responsible for providing this supervision.

Assisted Support

    Lake Jo staff are selected, trained and insured to deliver recreational programs only. Lake Jo staff are unable to tend to personal care or complex medical needs. The services of a personal caregiver (guide), is the responsibility of the guest.

    Lake Jo is unable to extend financial assistance for Guides (including family members and intervenors). Campers coming to camp for multiple sessions should be able to care for themselves for extended periods of time.

    If you or a family member require help with any of the following, you will be responsible for arranging for a guide while you are at camp:

    Eating

    Brushing teeth

    Grooming (shaving)

    Toileting

    Washing/showering/bathing

    Dressing

    Transferring to and from a wheel chair

    Getting self to and from program areas, dining room, etc.

    Getting to bed and waking in the morning

    Determining which programs to participate in

CNIB Lake Joseph Centre is not equipped to attend to complex

    medical or personal care needs.

Note: If a guest arrives at Lake Jo without a guide and it is later

    deemed that this guest requires the services of a guide, the guest will

    be asked to leave at their own expense and no refund will be granted.

    This includes major medical mishaps while at camp.

     I have read and understand the above policies.

    Each camper must sign the Lake Jo policies. If a camper is under the

    age of 18, a guardian must sign for the camper.

Signed

    Signed Signed Signed

    Date

Section 2

Waiver of Claim & Release

    Must be completed and signed by each camper.

    Name: Name: Name: Name:

Vacation Period:

In consideration for the following services and other good and valuable

    consideration provided to me by CNIB namely: a paying guest at the

    CNIB Lake Joseph Centre, MacTier, Ontario. I agree indemnify and

    save harmless CNIB, its organizers, agents, officials, servants and

    representatives from all liability and, without limiting the generality of

    the foregoing, from all claims, loss, damage, injury, liability, costs and

    expenses of whatsoever kind or nature (including legal fees)

    howsoever the same may be caused resulting directly or indirectly from

    the above mentioned work and/or services provided to me by CNIB, by

    its organizers, agents, officials, servants and representatives,

    notwithstanding that the same may have been contributed to or

    occasioned by (their) negligence.

I hereby consent to the use of my name, likeness and/or voice, in any

    media, without compensation, in any future publicity carried out by

    CNIB or the media in relation to CNIB.

Dated at (location)

This day of , (year).

    Witness:

    Guest/Guide Signature: Guest/Guide Signature: Guest/Guide Signature: Guest/Guide Signature: (If guest/guide is under the age of 18, the waiver must be signed by a

    parent/guardian.)

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