LONDON BEJE GYMNASTICS Summer Camp Registration Form
One Per Child
How did you hear about our summer camp?
Family Information
Contact Information
Contact 1
*
First Name
Last Name
Contact 1 phone number
*
-
Area Code
Phone Number
Contact 1 email
*
Contact 2
First Name
Last Name
Contact 2 phone number
-
Area Code
Phone Number
Contact 2 email
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Relationship
*
Aunt/Uncle
Grandparent
Family Friend
Other
Campers Information
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Has your child taken gymnastics lessons before?
*
Yes
No
Campers Medical Information
Doctor's Name
*
Health Card #
*
Please list any disabilities, special needs, and/or allergies
*
Does your child carry/administer their own medication
*
Yes
No
Waiver
By submitting this form, I
First Name
*
Last Name
*
acknowledge:
Certify that I am the parent or legal guardian of the child named above and I have full legal authority to make decisions regarding my child's participation in London Beje Gymnastics Summer Camp;
Understand that there is an inherent risk of injury, both minor and serious;
Certify that, to the best of my knowledge, my child is physically fit, in good health and I am unaware of any medical condition which might make my child's participation in London Beje Gymnastics Summer Camp inadvisable and I voluntarily assume all risks associated with my child's participate in London Beje Gymnastics Summer Camp;
Release and waive all claims, desmans, actions and suits made or brought against London Beje Gymnastics, arising as a result of any injury or loss suffered by my child or any other person on connection with my child's participation in London Beje Gymnastics Summer Camp and I agree to indemnify and save London Beje Gymnastics, including their respective officers, director, and coaching staff, harmless form and against all claims, demands, actions, or suits (whether groundless or otherwise) and from and against all liabilities, losses, costs, charges, counsel fees and other expenses of every nature or kind arising directly or indirectly from on in any way in connection with my child's participation in London Beje Gymnastics Summer Camp; and
Confirm that I have read, understood and agree to the terms and conditions
Date
-
Month
-
Day
Year
Date
Signature
*
Camp Week Information
Please pick your preferred week(s). Use the drop down option to pick Full or Half Day options.
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next
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Week 1: July 7th - 11th
$
Free
CAD
Full Week
Not This Week
FULL WEEK
Item subtotal:
$
0.00
CAD
Week 2: July 13th - 17th
$
Free
CAD
Full Week
Not This Week
FULL WEEK
Item subtotal:
$
0.00
CAD
Week 3: July 20th - 24th
$
Free
CAD
Full Week
Not This Week
FULL WEEK
Item subtotal:
$
0.00
CAD
Week 4: July 27th to July 31st
$
Free
CAD
Full Week
Not This Week
FULL WEEK
Item subtotal:
$
0.00
CAD
Week 5: Aug 10th - 14th
$
Free
CAD
Full Week
Not This Week
FULL WEEK
Item subtotal:
$
0.00
CAD
Week 6: Aug 17th - 21st
$
Free
CAD
Full Week
Not This Week
FULL WEEK
Item subtotal:
$
0.00
CAD
Week 7: Aug 24th- Aug 28th
$
Free
CAD
Full Week
Not This Week
FULL WEEK
Item subtotal:
$
0.00
CAD
Early Drop Off And Late Pick Up
$
Free
CAD
No
Yes, for the week
Yes, for a day
Item subtotal:
$
0.00
CAD
Subtotal
$
0.00
CAD
Tax
$
0.00
CAD
Total
$
0.00
CAD
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: