MARIE REINE DU CANADA
100 km Pilgrimage to Our Lady of the Cape
September 2, 3 4, 2006
To reserve your place in the pilgrimage,
please fill out and return both sides of this form as soon as possible, cash or cheque to “Our Lady of the Cape
Pilgrimage”. Applications without signed release/consent form (on the back
of this form) will be rejected. Pilgrims are responsible for their own transportation to Lanoraie on Friday, 1 Sept.
DATE OF BIRTH:__________________________________________________________________
NEXT OF KIN (name, coordinates): __________________________________________________
I WISH TO BE A:
WALKING PILGRIM o
WORKING PILGRIM o (a non-walking pilgrim who assists with heavy lifting, organization, driving and support. Same
I WILL BRING A TENT o TOTAL
TENT CAPACITY IS _______ , AND I AM WILLING TO SHARE MY TENT SPACE o
I REQUIRE A SPACE IN A SHARED TENT o
I HAVE FILLED OUT MY SIGNED RELEASE / CONSENT
FORM (see reverse) o
FEE: Includes basic meals, water, access to campsites. Full payment due
before August 15.
Total registration is
$55 ($45 for students). A second parent in the same family pays $45. A second, third, fourth, fifth student, etc. in the same
immediate family pays $35. Maximum per family: $200.
Double-Pilgrim Deal: Sign up a brand new,
first-time pilgrim and you pay only $35. (New pilgrim pays full price).
NOTE: In signing this form, I understand that this pilgrimage is a
rigorous feat of physical endurance and that I will be walking 100 kilometres in three days.
SIGNATURE: ____________________________. DATE: ________________________.
SIGNATURE OF PARENT (if under 18 yrs old): _______________________________.
Information: http://ladycape.tripod.com E-mail: NDduCap@hotmail.com
Marie, Reine du Canada
100 km Pilgrimage to Notre-Dame-du-Cap
September 1 to 4, 2006
Terms and Conditions
Note: Pilgrims (or,
if they are under 18, their Parent/Guardian) must read, sign and return this document in order to participate in the pilgrimage.
Pilgrims (walkers/workers) assume
responsibility for their health and the organizing committee of the pilgrimage shall not be liable to the pilgrim (walker/worker)
for any injury, sickness, or death to the pilgrim (walker/worker) out of any act, omission, or neglect on the part of the
committee of Our Lady of the Cape Pilgrimage from Lanoraie to Notre-Dame-du-Cap reserves
the right to accept, or reject, any person as a pilgrim, to expel any pilgrim from the pilgrimage, and to make changes in
the itinerary whenever it is deemed necessary to the comfort, convenience or safety of the other participants. The organizers
are not responsible for any criminal conduct by third parties.
assume all responsibility for any losses, damages, claims, personal injury, sickness, or death and shall indemnify and hold
harmless Our Lady of the Cape Pilgrimage and all of its organizers (the committee and chaplains) from any such losses, damages,
claims, personal injury, sickness, or death.
SIGNATURE OF PILGRIM
PLEASE PRINT YOUR NAME
SIGNATURE OF PARENT OR GUARDIAN IF UNDER 18
Please complete and return to: ‘Marie, Reine
du Canada’ Pilgrimage
87 Mann Avenue, Ottawa,
ON K1N 6Y8
No pilgrim may participate in the pilgrimage without completing both forms