YOUTH ADVENTURE CAMP: 2012 APPLICATION FORM
Please print this form out to complete and post, fax or e-mail it to us:
Broadleaf Guest Ranch, 5526 Route 114 Hopewell Hill, N.B. E4H 3N5
Fax: (506) 882-2075 E-mail: info@broadleafranch.com

Camper's Name: __________________________________________

Girl ____ Boy _____ Birthdate: (y) ____________(m)_____________(d) ______________
Tel#: _________________ Fax#: __________________ E-mail: _____________________
Address:________________________City______________Province_______Pcode._______
Do you prefer future correspondence to be by: E-mail _________ Fax _______Post ______

2012 CAMP DATES: (please indicate the appropriate week/s)

July 1 to 6 ______ July 8 to 13 ______ July 15 to 20______FULL July 22 to 27 ______
Aug. 5 to Aug. 10 ______ Aug. 12 to 17

Have you ever been to Broadleaf camps before? _________ If so, when? ______________
Have you ridden more that ten times? ________ Are you coming with a friend?_________
If so, what is their name? ______________________________

PARENT/GUARDIAN Name: (please print)_______________________

PARENT/GUARDIAN Signature: _______________________________

For your convenience, payments may be made by:
CHEQUE ______ VISA ______ MASTERCARD______ AMEX _______

Card number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Expiry date: _ _ / _ _
Amount: $_______ Card Holder's Name (please print)_____________________________
Please mail cheques payable to: Broadleaf Guest Ranch,
5526 Route 114 Hopewell Hill, N.B. E4H 3N5

FEES: The deposit is non-refundable.

One week at camp is $400.00 per week, tax included.
Deposit of 25% is required ($100.00), with the balance of $300.00 due upon arrival.

'Double the Fun' is $375.00 per week, tax included for campers who camp with us for two weeks or more. Deposit of 25% is required ($90.00), with the balance of $285.00 due upon arrival.

'Family Discount' is $375.00 per week, per child, tax included - for 2 or more brothers/sisters. Deposit of 25% is required ($90.00), with the balance of $285.00 due upon arrival.

Upon receipt of your application, we will forward your confirmation and a more detailed camper information form for you to fill out (medical history, waiver, and release of liability form). If you have any questions, we invite you to contact us at (506) 882-2349 / 1 800 226-5405 or Fax (506) 882-2075 or e-mail - info@broadleafranch.com. Your child's comfort and safety is our top priority.