Camp Promise Barrie Summer Camp Application Form
July 2024
Program Information
Start of Program: July 2, 2024 End of Program: July 26, 2024 Cost: $50 per week Program Times: 9:30am - 3pm
Contact Information
Allison Jacobson - 416-677-4274 Caroline Salvi - 647-871-4839 Email: info@camppromisebarrie.com
Registered with the Canada Revenue Agency
Please send a lunch and water bottle daily as well as weather appropriate clothing.
Snacks will be provided
Program Weeks
Please select the week(s) your child will be attending. *WEEK 2 is FULL
Week 1 - July 2-5, 2024 (JK-Gr 3) Location: 103 Clapperton St, Barrie
Week 3 - July 15-19, 2024 (Gr 4-6) Location: 284 Cundles Rd E, Barrie
Week 4 - July 22-26, 2024 (Gr 7-12) Location: 284 Cundles Rd E, Barrie
Child Information
*
First Name
Last Name
Preferred Name
Birth Date
*
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Day
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Year
Age
*
Gender
*
Please Select
Female
Male
Health Card Number
Medical Conditions/ Allergies/ Disabilities/ Special Needs (any support at school)
*
Name of School
*
Grade
*
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Residence Information
Current Address
*
Street Address
City
Province
Postal Code
Parent/Guardian Information
*
First Name
Last Name
Cell Phone
*
Please enter a valid phone number.
Home Phone
Please enter a valid phone number.
Other Phone
Please enter a valid phone number.
Email
*
example@example.com
Emergency Contact Information
Primary Emergency | Contact Name
*
First Name
Last Name
Primary Emergency | Relation to child
*
Primary Emergency | Phone Number
*
Please enter a valid phone number.
Other Phone
Please enter a valid phone number.
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Photographs or videos of your child taken during program may be used for promotional material. Please pick one of the following options.
*
Yes, I grant permission for my child to be in the photographs and videos that may be used for promotional material.
No, I do not grant permission for my child to be in the photographs and videos that may be used for promotional material.
Acknowledgement
I hereby grant permission for my child to participate in all activities of this program (which many include outings during program hours) and release Camp Promise staff from any and all liability, claims, demands, personal injury, sickness, death, as well as property damage and expenses of any nature whatsoever, which may be incurred by the child participant. Further, I grant permission to Camp Promise staff to authorize medical personnel to carry out the emergency procedure on my child in the case that I or the emergency contact, cannot be reached at the time of the incident. I have read and understood the waiver.
Date
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Year
Date
Signature
*
Payment:
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Summer @ Camp Promise
One week of summer camp. $50
$
50.00
CAD
Quantity
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Payment Methods
Debit or Credit Card
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