Camp Enrollment Form

Butterfly Camp Registration

Summer 2023
For Office Use ONLY- File Admission Date
For Office Use ONLY- File Discharge Date
Choose Your Adventure!

Pick your favorite weeks and then complete the enrollment below

Week 1 (July 4-7) Free to be, You & Me!$275.00CAD

Campers will enjoy getting to know each other while engaging in team building activities and icebreaker games. This week is all about teamwork, making friends, building confidence and coming together as one. Creativity will also come alive this week while campers participate in multiple art and crazy crafting experiences.

Week 2 (July 10-14) A Girlfriend's Week of Road Trips! $475.00CAD

Campers will be thrilled to experience a jam packed week full of exciting outings. This week will include 5 full days of excursions. Excursions planned for this week are; 1. A Farm Visit & Ice Cream Making Workshop 2. Berry Hill Farms & Jam Making Workshop 3. Wye Marsh Group Nature Experience 4. Kaleidoscope Play Centre 5. Kuruka Equestrian Basic Horse care, Riding Lesson & Equine Assisted Learning Transportation and Venue Admission Costs are Included

Week 3 (July 17-21) - Sassy Scientists!$315.00CAD

This week is all about crazy science experiments. Campers will engage in activities that will stimulate the mind and spark curiosity such as volcanic eruptions, bubble concoctions, messy science, ice and water experiments and chemical reactions.

Week 4 (July 24-28) Groovy Chefs!$325.00CAD

Campers will create their own culinary masterpieces everyday of this exciting week as well as participate in a final "cook off" on their last day! Recipe books will come home at the end of this delicious week!

Week 5 (July 30-August 4) A Girlfriend's Week of Road Trips 2! $475.00CAD

Campers will be thrilled to experience a jam packed week full of exciting outings. This week will include 5 full days of excursions. Excursions planned for this week are; 1. Rounds Ranch - Sunflower Festival 2. Elmvale Zoo 3. Bowling 4. Funvilla Play Centre 5. Kuruka Equestrian Basic Horse care, Riding Lesson & Equine Assisted Learning Transportation and Venue Admission Costs are Included

Week 6 (August 8-11) Van Gogh Girls - Art Extreme$300.00CAD

In addition to girl power activities, camp games, water fun and girl time, our van Gogh girls will feel like true artists while they experience painting on canvas, sculpture, vinyl art, abstract art, bead art, stamping and card making. Campers will also create their own virtual art gallery that their amazing masterpieces will be showcased in for all to see at the end of this special week. When it comes to fun and art, anything goes! Cost of all materials included

Week 7 (August 14-18) Water & Wellness Week!$300.00CAD

Get ready to participate in our water extravaganza week where campers will challenge each other to different water games, competitions and enjoy all things water! This week will also include a visit to the local splash pad. Prepared to get SOAKED! This week campers will also learn yoga and basic meditation, some taewondo and even experience fun fitness Zumba so they can dance to the music!

Week 8 (August 21-25) Fashion Show Frenzy$325.00CAD

This week is all about fashion and girl power! Campers will work together to plan, organize and implement their own fashion show. Campers will make their own fashionable jewelry and accessories to wear in their fashion show finale.Campers will enjoy a fun spa day using their own homemade facials, and give each other simple manicures and pedicures! Costs of materials included

Extended Care - Mornings (7:00am-8:30am)$81.25CAD

Optional extended care from 7am until camp starts at 8:30am. Please select the number of weeks that you require this option.

Choose your week(s)	Select the weeks required
July 4-7
July 10-14
July 17-21
July 24-28
July 30-Aug 4
Aug 8-11
Aug 14-18
Aug 21-25

Extended Care - Afternoons (4:30am-5:45pm) $81.25CAD

Optional extended care after camp ends from 4:30pm until 5:45pm. Please select the number of weeks that you require this option.

Choose your week(s)	Select the weeks required
July 4-7
July 10-14
July 17-21
July 24-28
July 30-Aug 4
Aug 8-11
Aug 14-18
Aug 21-25

One Time Registration Fee$40.99CAD

This fee pays for administrative costs associated with your child's enrollment as well as a small portion of the online payment processing fees.

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Total $0.00CAD

Credit Card

CHILD INFORMATION:
Camper's Name*

First NameLast Name
Birth Date*

MonthDayYear
Age as of June 30, 2023*
Grade*
Camper's Home Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Home Phone Number*
Who does the camper live with?

Both ParentsFatherMotherGrandparent(s)Foster Parent(s)
Are there any access orders/agreements, court orders or custody documents regarding this camper?

YesNo
Previous school camper attended:
Sibling #1 Information

NameAgeSchool
Sibling #2 Information

NameAgeSchool
Sibling #3 Information

NameAgeSchool
Language(s) Spoken at Home*
PARENT/GUARDIAN INFORMATION:
Parent/Guardian #1 Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Home Phone Number*

Area CodePhone Number
Mobile Phone Number*
Occupation*
Name of Work Place*
Work Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Phone Number*

Area CodePhone Number
E-mail*
Does parent/guardian #2 have the same address as parent/guardian #1?*

YesNoThere is no second parent/guardian
Parent/Guardian #2 Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Phone Number*

Area CodePhone Number
Mobile Phone Number*
Occupation*
Name of Work Place*
Work Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Phone Number*

Area CodePhone Number
E-mail*
example@example.com
Alternate Emergency & Child Release Information

Please provide two alternate adults (other than parents/guardians listed above) that can be contacted in an emergency and that you permit your child to be released to if needed.
Emergency Alternate Adult #1*

First NameLast Name
Relation to child*
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Phone Number*

Area CodePhone Number
Work Phone Number*

Area CodePhone Number
My child can be released to this person*

yesno
Emergency Alternate Adult #2*

First NameLast Name
Relation to child*
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Phone Number*

Area CodePhone Number
Work Phone Number*

Area CodePhone Number
My child can be released to this person*

yesno
MEDICAL INFORMATION
Physician Name*

First NameLast Name
Physician Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Health Card Number*
Does this camper have any physical limitations that we need to be aware of?*

yesno
If yes, please provide details
Are there any other social, emotional, physical or medical details that may be helpful for us to know?*
If there is no additional information please indicate n/a
Please list all allergies/medical concerns/special needs. (Please indicate "none" if none are present)*
(Please describe/if none, please indicate with "none")
Does this camper require an Epi-pen?*

yesno
If yes, please provide details
Does this child take medications on a regular basis?*

yesno
If yes, please provide details
Does your child currently have an IEP or an ISP?*

YesNo
What is your child's diagnosis?
Please upload a copy of your child's IEP or ISP

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Please upload your child's most current immunization record(s) or signed medical exemption certificate*

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History of Communicable Diseases: Please indicate if this child has had any of the following:*

Chicken PoxWhooping CoughMumps (German Measles)RubellaMeaslesHepatitis BNone
Please indicate any additional information regarding skin disorders, sight and/or hearing difficulties. (Please indicate "none" if none are present)*
Please indicate any food restrictions (allergy/religious) or food sensitivities that we should be aware of. (Please indicate "none" if none are present)*
Please click here to submit your child's photo for our reference*
I give my child permission to apply the following topical products to themself during their time at camp. All products will be provided only by me for my child's use.*

SunscreenInsect RepellentNone
Parent/Caregiver Signature*

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Service Contract and Policy Agreement

Please complete by signing on the line provided for each agreement. By signing each statement you are agreeing to the terms of our service.
I have read through The Kinder Garden's/Woodland Wonders camp guide and Handbook and understand and agree to comply with all rules, policies and procedures stated within. (Please sign below)*

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Camp runs daily from 8:30am-4:30pm. Please note that we do have extended care options available above. I understand that I am responsible for a "late pick up fee" of $20 per 15 minutes or part thereof in the event that I arrive or leave the building after the posted closing time. This payment is due upon arrival on my child's next day or attendance and is to be paid in cash to the team member who stayed late with your child. (Please sign below)*

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I understand that my child will not be released to anyone other than the people listed on my child's enrollment forms under Emergency Contacts who I have indicated that my child may be released to. It is my responsibility to inform staff when an emergency person will be picking my child up. My emergency people are required to present government issued identification to staff at the time of pick up. (Please sign below)*

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I understand and agree that I am responsible for full payment of my child's scheduled days at any of The Kinder Garden's programs, including Woodland Wonders, Butterfly camp and school age programs. I will be charged a fee of $60 for payments that are returned from my financial institution. I also understand that there is no fee exemption due to illness, weather, vacation, absence, holiday closures or termination of my child's service by The Kinder Garden/Woodland Wonders as outlined in the Family Handbook. I understand that once I secure a space for my child by way of payment that my space is non-refundable. (Please sign below)*

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I have read through the illness/sick policy and have a clear understanding of what is expected. I understand that for health and safety reasons I cannot knowingly send my child to The Kinder Garden/Woodland Wonders without disclosure of any known medical conditions, illness, fever and/or allergy information and doing so may result in my child's immediate termination from their program. (Please sign below)*

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Media Consent: Please select one or more to indicate your consent regarding how your child's art work and photos may be used by The Kinder Garden Children's Centre/Woodland Wonders.*

I give permission to The Kinder Garden/Woodland Wonders to photograph, audio record and/or video tape my child for the purpose of professional development within the organization.I give permission to The Kinder Garden/Woodland Wonders to display my child's work including art, class photos and individual photos within the centre and in the classroom learning story binders.I give permission to The Kinder Garden/Woodland Wonders to post photos of my child engaging with their educators and peers on the organizations website and/or social media account as a way to share how children learn with our local community.
Parent Consent Signature*

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Community Walks: Often we like to include walks in and around our community as part of our program. Staff to child ratios will not be reduced during times that the children are outside as regulated by the Child Care and Early Years Act and The Ministry of Education.
I First Name* Last Name* give The Kinder Garden Children's Centre/Woodland Wonders permission to take my child: First Name* Last Name* on walks within the community. I understand that the children will always be walking with qualified staff members of The Kinder Garden/Woodland Wonders. Date*
Parent Consent Signature*

Clear
Personal Information: I hereby consent to the collection, use and disclosure of my child's information by The Kinder Garden/Woodland Wonders for the purposes of providing camp and/or child care services to my child enrolled in centre programs. I understand that the centre protects the privacy of all personal information in its possession in compliance with prevailing privacy legislation. (Please sign below)*

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How did you hear about us!*

Billboard AdvertisementFacebookMobile Sign AdvertisingWord of MouthGoogle Search
Terms and Conditions*
Signature
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Butterfly Camp Registration

Choose Your Adventure!

Credit Card

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION:

Alternate Emergency & Child Release Information

MEDICAL INFORMATION

Service Contract and Policy Agreement