LTD application, level 2&3, 2012

Welcome! Welcome to the returning LTD application form! I am glad that you are wanting to continue. Please answer all the questions honestly and openly because it's important for me to get an idea of where you are at. As always if you have any questions, please contact me, ben@gulllakecentre.ca or 403-782-2495.
~Personal Information~
- First Name *
- Last Name *
- Email *
- grade this fall * what grade will you be entering this fall?
- Birthday * Example: February 15, 1982
- Sex * MaleFemale
- - Your Address *
  - City *
  - Province *
  - Postal Code *
  - Primary phone # *
  - Secondary phone #
- ~Other information~
- Health Care Number *
- Health Care providing province *
- Please list any allergies or food allergies that you have
- Please list any medication that you will be bringing with you and reasons for taking them
- Is there any medical history or condition we should be aware of? If yes then please explain.
- Current Church *
- Church Attendance * Regularly AttendOccasionally AttendSeldom Attend
- Name of the person to notify in an emergency *
- Primary phone # *
- Secondary phone #
- ~ Contact Info~
- ~the program~
- Why do you want to continue with the ltd program? *
- What do you hope to get from the ltd program this year? *
- What do you hope to give to the ltd program this year? *
- ~your past year~
- What has been the most significant event (good or bad) of your past year? *
- Since the summer, has your life reflected Christ? Please explain. *
- How are things with you and your mentor? *
- How have you been involved in your church over the past year? What have you learned from it?
- How would you change the ltd program if you could?
- Are there any session topics you would like to see at ltd week this year?
- Any other thoughts or comments?
- ~dates, out trips & practicums~
- ltd week is June 30-July 6/2012
- level 2 out-trip choice first outtrip(July 22-27)second outtrip(Aug 12-17)either is ok
- level 3 out trip The level 3 out trip is going to the Mustard Seed in Edmonton for their Student Urban Placement program. The dates for the trip are July 15-20/2012
- practicum For this section indicate how many weeks you would like to serve and then which weeks you are available and what type of practicum(jr cabin leading, service or program)
- scamper camp(ages 5-7) June 22-24
- jr teens1 (ages 12-14) July8-13
- Inter 1 (ages 9-12) July 15-20
- family camp (all ages) July 22-27
- inter 2 (ages 9-12) July 29-Aug 3
- jr boys&girls (ages7-10) Aug 7-10
- jr teens 2 (ages 12-14) Aug 12-17
- practicum, how many weeks 1 week2 weeks3 weeks4 weeks
- From the above choices, what are your prefered practicum weeks and type of service?
- #1
- #2
- #3
- #4
- Parent or Guardian Release - please read carefully Gull Lake Baptist Camp Ltd. (Gull Lake) conducts camps for children and adults on a yearly basis. Every precaution is made to ensure the safety and well-being of each camper. Even with normal camp activities such as outdoor games and contact sports there are certain risks involved. I understand and accept these potential risks and, by my signature below, am bound to release forever, Gull Lake and all individuals associated with it, from any and all liability for injury or damage which may be sustained by the undersigned and/or child of the undersigned, or property of the same at or in transit to or from any camp conducted activity, or under the auspices of Gull Lake. In the case of emergency, I give permission for Gull Lake and the physician selected by the camp to utilize local ambulance/EMT services, hospitalize, secure proper treatment for, and order injection or surgery as deemed necessary for the health and well-being of my child or person named on this registration form. I give Gull Lake permission to administer any required over-the-counter medications and/or medications prescribed to my child by their physician. I also give Gull Lake the right to use pictures or videos of the camper for promotional purposes.
- familiarization I have familiarized myself with the LTD program from the information I have read and am in agreement with this application to enter level One. As best I can I will support Gull Lake Camp in the LTD program goals to help my child grow as a follower of Christ, to become more like Him in the way He leads and serves others. I have read and understood this release.
- parent/guardian name *
- ltd agreement I understand my responsibility to participate in all aspects of the program including the on-campus training week, out trip, summer and winter practicums and fall and spring retreats. I understand and agree to pay all registration expenses($650) upon my re-acceptance into the program by June 1, 2012.(The cost of the LTD program is approximately $800 per student. The camp pays for $150 per student and the remaining $650 is the responsibility of the student to pay for. Each student will receive a letter to ask their church for support as well , hopefully covering $150 of the student’s cost. We believe that the camp benefits by having you as an LTD, your church benefits by you seeking leadership training and you benefit by being discipled. The plan is that all three of these help cover the cost of the program)
- ltd name *
- Make sure that you have filled in all of the necessary information. When you are sure that you have completely filled in the information press the SUBMIT button below.

2012 REGISTRATION IS OPEN

Camp	Age	Date	Cost
Scamper camp	5-7	June 22-24	$120
JR Teens 1	12-14	July 8-13	$335
INTER 1	9-12	July15-20	$315
Family Camp	all ages	July 22-27	see costs
INTER 2	9-12	July29-Aug3	$315
JRBG	7-10	Aug 7-10	$230
JR Teens 2	12-14	Aug12-17	$335
SR Teens	14-18	Aug 19-25	$370

Upcoming Events

Work Party Week June 11 - 17, 2012

Live at the Lake Nov. 9 - 11, 2012

Family Advent Retreat Nov. 23 - 25, 2012

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