Snails and Trails Summer Camp Registration Form

Snails and Trails Nature Program

Summer Day Camp Registration
Childs Information
Childs Name

First NameLast Name
Birth Date

MonthDayYear
Grade
MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Snails and Trails Day Camp
prevnext( X )
Week 1 July 6 - July 10th
Children ages 5-10

$320.00CAD



Week 2 July 13 - 17th
Children ages 5-10

$320.00CAD



Choose my days at $70/day Organize by email beckysnailsandtrails@gmail.com
Children ages 5-10

$ FreeCAD Quantity



Both Week 1 and 2 (July 6-17th)
Children ages 5-10

$600.00CAD Quantity



Total

$0.00CAD
If you have and questions or comments about Snails and Trails Day Camp (Here)
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Does your child have a prescribed an inhaler? If yes, please explain any instructions.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Snails and Trails Nature Program during the selected camp. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Snails and Trails Nature Program.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
Date
Signature
Should be Empty:

Snails and Trails Nature Program

Childs Information