Summer Dayz Program Registration Form
Fill out the form carefully to register your child, you must fill out an additional form for each child you register! *Please Note* You must pay by credit card using this form, for other payment options please email recreation@langenburg.ca
Participants Name
*
First Name
Middle Name
Last Name
Birth Date
Please select a month
January
February
March
April
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June
July
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Month
Please select a day
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Day
Please select a year
2026
2025
2024
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Year
Gender
Please Select
Male
Female
N/A
Parents Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parents E-mail
example@example.com
Parents Mobile Number
Format: (000) 000-0000.
Work/Other Number
Format: (000) 000-0000.
List of allergies or medical concerns:
Child's Health Card #
Please choose which days/weeks your child will be participating:
Categories:
All
All
FULL WEEK
DAY PASS
prev
next
( X )
FULL WEEK
FULL WEEK July 4-7
$
45.00
CAD
FULL WEEK - July 11-14 FULL!
$
Free
CAD
FULL WEEK July 18-21
$
45.00
CAD
FULL WEEK - July 25-28
$
45.00
CAD
FULL WEEK - Aug 2-4 - STAT
$
33.00
CAD
FULL WEEK - Aug 8-11
$
45.00
CAD
FULL WEEK- Aug 15-18
$
45.00
CAD
FULL WEEK- Aug 22-25
$
45.00
CAD
DAY PASS
DAY PASS - July 4th
$
12.00
CAD
DAY PASS - July 5th
$
12.00
CAD
Day Pass July 6th
$
12.00
CAD
DAY PASS - July 7th
$
12.00
CAD
DAY PASS - July 18
$
12.00
CAD
DAY PASS - July 19
$
12.00
CAD
DAY PASS- July 20
$
12.00
CAD
DAY PASS - July 21
$
12.00
CAD
DAY PASS - July 25
$
12.00
CAD
DAY PASS - July 26
$
12.00
CAD
DAY PASS - July 27
$
12.00
CAD
DAY PASS - July 28
$
12.00
CAD
DAY PASS - Aug 2
$
12.00
CAD
DAY PASS - Aug 3
$
12.00
CAD
DAY PASS - Aug 4
$
12.00
CAD
DAY PASS - Aug 8
$
12.00
CAD
DAY PASS - Aug 9
$
12.00
CAD
DAY PASS - Aug 10
$
12.00
CAD
DAY PASS - Aug 11
$
12.00
CAD
DAY PASS - Aug 15
$
12.00
CAD
DAY PASS - Aug 16
$
12.00
CAD
DAY PASS - Aug 17
$
12.00
CAD
DAY PASS - Aug 18
$
12.00
CAD
DAY PASS - Aug 22
$
12.00
CAD
DAY PASS - Aug 23
$
12.00
CAD
DAY PASS - Aug 24
$
12.00
CAD
DAY PASS - Aug 25
$
12.00
CAD
Credit Card
Elements of Risk: Summer activity programs, such as the Summer Dayz Program may contain certain elements of risk. The instructors will attempt to minimize these risks by providing the appropriate level of supervision while the children are under their care. Accidents may, however, occur while participating in these activities, and these accidents may cause injury. The accidents that may result from the nature of this program can occur without any fault on either the part of the child or the Langenburg Summer Dayz Program and its instructors and employees. By choosing to participate in this program, you, as a parent or guardian, are assuming the risk of an accident occurring that involves your child. The chances of an accident occurring can be greatly reduced by having your child listen to and carefully follow the leader’s instructions at all times. Waiver: I have read the above, and I certify that my child is in good health and able to participate in vigorous activities through Langenburg Summer Dayz Program and I authorize the directors to seek emergency medical treatment if it is deemed necessary. This also assures that I release the instructors, facilities and Langenburg Summer Dayz Program from any and all liability from any injury or illness incurred going to and from the program and while participating in a program. I agree to hold harmless the instructors, facilities, Langenburg Summer Dayz Program and its operators of all liabilities for losses and/or damages of all and every description.
*
Submit Application
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