Guest Registration - Bass Fishing Day

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Bass Fishing Day is a very special day at ADA Camp Carefree. The day is filled with boat rides on Merrymeeting Lake, fishing for pan fish and bass, a casting contest where the winners have the opportunity to compete at the state level competition, and other activities provided courtesy of diabetes supplies manufacturers, Wal-Mart pharmacy, and regional ADA staff.

For safety reasons, Guests must always be under the direct supervision of ADA Camp Carefree staff. Guests are also welcome to join us for meals if your activity or agreed upon time goes across a meal time. Specific programs at camp which greatly benefit the campers could not run without our Guests!

If you will be participating in Bass Fishing Day, please complete the form below to register to be a GUEST of ADA Camp Carefree. Please note that this information will be included in our annual Address Book as a way of saying thank you for your participation.

Name (first and last, please)*:

Street Address (line 1)*:

Street Address (line 2):

City*:

State*:

Zipcode*:

Best Phone # to reach me*:

This is my (please select one):

Home Phone

Work Phone

Cell Phone

Email Address*:

Birthday (month/day only - no year please)*:

Will you be at least 18 years old by August 1 of this year? (please select one)

Yes

Purpose of your visit (please check all that apply):

Bass Fishing Day Boater - 8/5 (will bring boat)

Bass Club/Other Affiliation:

Bass Fishing Day Casting Contest - 8/5

Bass Club/Other Affiliation:

Bass Fishing Day Land Activities - 8/5

Bass Club/Manufacturer Affiliation:

American Diabetes Association Representative

ADA Office:

Is this your first time at ADA Camp Carefree?

Yes

No, I last visited camp in (please provide year):

ADA Camp Carefree 2010 Calendar
SUN	MON	TUE	WED	THU	FRI	SAT
8/1 Camp Opens	8/2	8/3	8/4 Bass Fishing Day	8/5	8/6	8/7
8/8	8/9	8/10	8/11	8/12	8/13	8/14 Camp Closes 12 noon

Please check one of the following as it pertains to your schedule for arriving/leaving camp:

I plan to visit camp on the following days:

I’m not sure of exact days/times right now, but I will let you know by the following date:

I plan to arrive on this date:
I plan to arrive at this time:
I plan to leave on this date:
I plan to leave at this time:

I plan to stay for the following meals:

None

Breakfast

Lunch

Dinner

All Meals

I plan to stay overnight:

Yes, and I agree to complete the Voluntary Disclosure Form (provided upon submission of this registration) if I am not an ADA Representative.

I need to be contacted to make special arrangements:

Yes

I am the invited guest of:

Name:
Position:

I have read and agree to abide by the Visitor and Guest Policy, the daily camp schedule, the camp rules, and I can’t wait to come to CAMP!

Yes

Form verification code: please type the code

in the box below before submitting the form.

Thank you for taking the time to complete this form.

We look forward to seeing you soon!

*Required Fields