2023 Eco Kids Summer Camp Registration Form

Eco Kids Summer Camp 2024
CHILD/CHILDREN INFORMATION:
1) Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
2) Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
3) Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
4) Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Medical Information
Physician Name*
Physician Number*
Medical Concerns, Required treatment, name of child (if more than one). Should ambulance be called?
Is your child presently being treated for an injury, illness or taking any form of medication? If yes, please explain.
Does your child require a special diet? If yes, please explain.
Emergency Contact
Name*
Contact Number*
Email
Relation to Child(ren)*
Not including the parent/guardian listed above, please list any additional persons permitted to pick up your child/children:
Registration and Payment
Will you require FULL DAY care for your child/children (8:30am- 4:30 pm)?*

YESNO
Drop-off location: Buchanan Teaching Garden 360 Niagara St. At the main garden gates where the parking lot is.

Drop-off time: 9:00 AM. Early drop-off is 8:30AM,

Pick-up time: 4:00 PM, Extended drop-off is 4:30 PM
- $180 per child/ per week.
- Full payment is required in order to submit registration

Payment: Each week has a different theme. Please indicate the week(s) you are registering for:*

Week 1 - July 8 - 12 Where Adventures Begin$180.00CAD

Number of Kids
Item subtotal:$0.00CAD

Week 2- July 15 - 19 Eco-Art Innovators$180.00CAD

Number of Kids
Item subtotal:$0.00CAD

Week 3- July 22- 26 Eco-Kids Gardeners $180.00CAD

Number of Kids
Item subtotal:$0.00CAD

Week 4- July 29 - August 2 Healthy Eco-Kids$180.00CAD

Number of Kids
Item subtotal:$0.00CAD

Week 5- August 6 - 9 * Earth Protectors$145.00CAD

Note: Special price for week 5 $145.

Number of Kids
Item subtotal:$0.00CAD

Week 6- August 12 - 16 Active Kids$180.00CAD

Number of Kids
Item subtotal:$0.00CAD

Week 7- August 19 - 23 Splishy Splash$180.00CAD

Number of Kids
Item subtotal:$0.00CAD

Enter coupon

Total $0.00CAD

Eco Kids Summer Camp 2024