Pathfinders Program Detailed Registration Form

Participant Information
Participant Name

First NameLast Name
Birth Date

MonthDayYear
Sex

MaleFemaleOther
Address

Street Address

CityState / Province

Postal / Zip Code

Parent/Guardian Information
Mother's Name

First NameLast Name
Mother's Profession
Mother's Cell Phone Number
Mother's e-mail
example@example.com
Father's

First NameLast Name
Father's Profession
Father's Cell Phone Number
Father's e-mail
example@example.com
Home Phone Number
Parental Marital Status

MarriedDivorcedWidowedRemarriedOther
Name of Step Parent

First NameLast Name
Step Parent Phone Number
Name of Guardians if camper is in Foster Care

First NameLast Name
Guardians Phone Number
Guardians e-mail
example@example.com

Important Contact Information
Doctors Name

First NameLast Name
Doctors phone number
Social Worker's Name

First NameLast Name
Social Workers Phone Number

Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
Campers Medicare card number and expiration date*
Allergies, chronic illness, or medical conditions? If yes, please describe.*
**A separate camper health form must be filled out prior to the start of camp****Please notify the camp if there are any changes to the camper’s medical history after completing these forms**

Campers Information
What are your participant's interests, special skills (does he or she like sports, art related activities, music, games, what are their fears, dislikes, ect...)
Please explain in as much detail as possible about your participant's emotional and intellectual development and specific difficulties. The clearer understanding we have of your young adult, the better we can adapt a wonderful summer program to meet his/her specific needs.
Please include a picture of the Participant

Cancelof

Conditions of Enrollment Pathfinder 2023-2024

Note: Trails Recreation Center will hereafter be referred to as 7730616 Canada Association(abbreviated 7730616).

Cost Breakdown

Session 1 (October 3rd - December 21st/12 weeks): $150/week (fees include program registration fees, supplies for life skill training, program T-shirt, daily snacks, and swimming twice-weekly).

Week 1: October 3rd-5th

Week 2: October 10-12th

Week 3:October 17-19th

Week 4:October 24-26th

Week 5 October 31 - November 2

Week 6: November 7-9th

Week 7: November 14-16th

Week 8: November 21-23rd

Week 9: November 28-30th

Week 10: December 5-7th

Week 11: December 12-14th

Week 12: December 19-21st

Session 2 (January 9th - March 28th/11 weeks): $150/week (fees include program registration fees, supplies for life skill training, program T-shirt, daily snacks, and swimming twice-weekly).

Week 1: January 9-11th

Week 2: January 16-18th

Week 3 January 23-25th

Week 4: January 30- February 1st

Week 5: February 6-8th

Week 6: February 13-15th

Week 7:February 20-22nd

Week 8: February 27-29th

MARCH BREAK

Week 9: March 12-14th

Week 10: March 19-21st

Week 11: March 26-28th

Session 3 (April 2nd - June 13th/11 weeks): $150/week (fees include program registration fees, supplies for life skill training, program T-shirt, daily snacks, and swimming twice-weekly).

Week 1: April 2-4th

Week 2: April 9-11th

Week 3:April 16-18th

Week 4: April 23-25th

Week 5: April 30- May 2nd

Week 6:May 7-9th

Week 7:May 14-16th

Week 8:May 21-23rd

Week 9:May 28-30th

Week 10: June 4-5th

Week 11: June 11-13th

All 3 Sessions 1,2 &3: (October 3rd - June 13th):$225/week (fees include program registration fees, supplies for life skill training, program T-shirt, daily snacks, and swimming twice-weekly).

Winter Break: Camp program available (January 1-5)

March Break: Camp program available (March 4-8)

* Payment must be paid per month

PAYMENT OPTIONS:

You can send a check to 7730616 Canada Association

6800 Macdonald Cote St. Luc #303

H3X3Z2

OR send an e transfer to sheldonpronman@yahoo.com with the security word being camp [ all in small letters].

If an individual is found a danger to himself or herself or others. Their stay may be terminated or a private shadow will be needed.
*This includes if the participant requires more care than the director feels the staff is able to provide. No refund will be issued.

By signing this document, parents authorize the use of any photographs or other forms of media taken of the participant during their time at the camp for publicity purposes such as brochures. All materials used will remain the property of 7730616.

At Trails Recreation Center we continue to strive to make each participant stay safe and magical with memories to last a lifetime!

Can’t wait to see ya on the trail!
Date

MonthDayYear
Date
Signature*

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Parents agree to release and indemnify 7730616 Canada Association doing business as Trails Recreation Center, owner, director and all other staff from any and all claims for damages arising as a result of any accident, injury or otherwise sustained by the here in named child arising from participation in any camp activities, wherever they may be, either on or off camp property
Campers Name

First NameLast Name
Parent/Guardian Name

First NameLast Name
All parties agree that the language of this contract is in English.
Date

MonthDayYear
Date
Signature of parent or Guardian*

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Les parents acceptent de ne pas engager de poursuites judiciaires contre 7730616 Canada Association, Trails Recreation Center le propriétaire, le directeur et tous les employés, résultant de dommages survenus lors d'un accident quelconque ou d'une blessure subie par l'enfant participant a l'une ou l'autre des activités du camp, qu'elle soit survenue sur les lieux du camp ou a l'extérieur de ceux-ci.
Nom de l'enfant

First NameLast Name
Nom du parent our tutuer

First NameLast Name
Toutes les personnes acceptent que la langue de ce contrat soit en anglais.
Date

MonthDayYear
Date
Signature du parent ou tuteur*

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Pathfinders Day Program: Registration