2008 WEEKEND FAMILY CAMP REGISTRATION

OCTOBER 17, 18 & 19, 2008

ROSES   GAP  RECREATION   RESERVE

Cost (inclusive of GST) $77.00 per family-- $33.00 Grandparents or extra persons other than family. And $25.00 for helpers.

All families and single persons attending the camp need to be members of the Wimmera Hearing Society for insurance purposes. $10.00 per family and $5.00 for singles or pensioners. Contact us for membership.

FAMILY NAME……………………………………. Please PRINT

ADDRESS……………………………………………

E-mail ……………………………………………………………………………

TELEPHONE………………………………

PARENTS GUARDIANS NAMES………………………………………………………….

Child(ren)s names                                           DoB                        Hearing impaired

……………………………..                                         ………….                        Yes/No

……………………………..                                         …………..                       Yes/No

…………………………….                                         .………….                        Yes/No

HELPER IN CHILDREN'S PROGRAM

NAME/S…………………………………………………………………

GROUP:  0-5years     5-10years    10years