2017 Adventure Camp 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: _________________________________ (Please print clearly)

Address: _________________________ City ___________________

Province_______ Postal Code _______

2017 CAMP DATES: (please indicate the appropriate week/s)

July 9 to 14 ______ July 16 to 21 ______ July 23 to 28 ______

July 30 to Aug. 4 ______ Aug. 13 to 18 _____
Aug. 20 to 25 _____

Have you ever been to Broadleaf Summer Camps before? _________ If so, when? ________

Have you ridden more than ten times? ______

Are you coming with a friend? ______ If so, who? ________________

PARENT/GUARDIAN Name: (please print) _______________________

PARENT/GUARDIAN Signature: _______________________________

Please check method of payment:
CHEQUE ______ VISA ______ MASTERCARD______ AMEX _______

Card number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Expiry date: _ _ / _ _

Amount: $_______ Card Holder's Name(please print) _____________

If paying by cheque, please mail payable to: Broadleaf Guest Ranch,
5526 Route 114 Hopewell Hill, N.B. E4H 3N5


FEES: The deposit is non-refundable.

FEES: Deposit of $100.00 is due upon registration and the balance due at arrival. 50% ($50) of the deposit is non-refundable.

One week at camp is $450.00 per week, plus tax.
'Double the Fun' is $425.00 per week, plus tax for campers who attend camp for two weeks or more.

'Family Discount' is $425.00 per week, per child, plus tax - for 2 or more brothers/sisters.

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.

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