YOUTH ADVENTURE CAMP: 2007APPLICATION FORM

Please print this form out to complete, and post it to us: Broadleaf Guest Ranch, 5526 Route 114 Hopewell Hill, N.B. E4H 3N5

Campers 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 _________

2007CAMP DATES: (please indicate the appropriate week/s)

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

Card number: _ _ _ _   _ _ _ _   _ _ _ _   _ _ _ _  Expiry date: _ _ / _ _ Amount: $

Card Holder's Name (please print)__________________________________________

Camper's Name________________________________________

Please mail cheques payable to: Broadleaf Guest Ranch,
5526 Route 114 Hopewell Hill, N.B. E4H 3N5

FEES:

One week at camp is $350.00 per week, tax included.
Deposit of 25% is required - $87.50 - with the balance of $262.50 due upon arrival. The deposit is non-refundable.

'Double the Fun' is $325.00 per week, tax included - for campers who camp with us for two weeks or more.
Deposit of 25% is required - $81.25 - with the balance of $243.75 due upon arrival. The deposit is non-refundable.

'Family Discount' is $325.00 per week, per child, tax included - for 2 or more brothers/sisters.
Deposit of 25% is required - $81.25 - with the balance of $243.75 due upon arrival. The deposit is non-refundable.

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 e-mail - info@broadleafranch.com. Your child's comfort and safety is our top priority.

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