2024 Winter Day Camp Registration Form
Join us for the 3rd annual Winter Day Camp at MHV during the Winter break. Registration is available for children aged 6-11.
Camper's Information
How many campers are you registering today?
*
Please Select
1
2
3
4
Total Cost
Date
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Month
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Day
Year
Date
Camper Name
*
Date of Birth
*
-
Month
-
Day
Year
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Age
Camper 2 Name
*
Date of Birth 2
*
-
Month
-
Day
Year
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Age
Camper 3 Name
*
Date of Birth 3
*
-
Month
-
Day
Year
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Age
Camper 4 Name
*
Date of Birth 4
*
-
Month
-
Day
Year
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Age
Note -
Registration is for children aged 6 - 11.
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Parents' Information
Parent/Guardian 1
Parent/Guardian 1
*
First Name
Last Name
Relationship to Child
*
E-mail
*
example@example.com
Cell Phone
*
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Where would you like to be reached while your child is at camp?
*
Cell Phone
Work Phone
Home Phone
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Parent/Guardian 2
Parent/Guardian 2
First Name
Last Name
Relationship to Child
E-mail
example@example.com
Cell Phone
Format: (000) 000-0000.
Home Address Same as Parent/Guardian 1?
Yes
Home Phone
Format: (000) 000-0000.
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Future Opportunities
Yes, allow MHV to contact me in regards to future Day Camp opportunities.
Contact Permissions
E-mail
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Emergency Contacts/Authorized Pickup
Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the center/home, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age.
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Emergency Contact #1
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone Number
*
Format: (000) 000-0000.
Relationship to Child
*
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Medical / Health Information
Name of Physician or Clinic/Hospital
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Does your child have any food, medication or environmental allergies?
*
Yes
No
Which Child does this apply to?
Allergies? Check all that apply
*
Food
Medication
Environmental
Please list and explain any allergies
*
0/150
Does your child have a special health or medical condition?
*
Yes
No
Please explain
*
0/150
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Payment and Statement of Understanding
Sign Document
*
Date Signed
*
-
Month
-
Day
Year
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How would you like to pay?
Online
Debit/Credit/Cheque/Cash at MHV (payment is due by Dec. 23, 2023 - office is closed for the holidays after this date)
Registration Fees
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CAD
Total fees - $99/child
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