Banyan Ed. - Summer Camp 2025 Form

Camper Information

Please fill out a separate form for each camper.
Camper's Name *

First NameLast Name
Grade entering in Fall*
Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name 1 *

First NameLast Name
Cell Number *
Please enter a valid phone number.
Home Number
Please enter a valid phone number.
Email *
example@example.com
Name 2

First NameLast Name
Cell Number
Please enter a valid phone number.
Home Number
Please enter a valid phone number.
Email
example@example.com
Emergency Information
Name *

First NameLast Name
Relationship
Phone Number*
Alternative Phone Number*
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.
Informed Consent and Acknowledgement
I hereby give my approval for my child’s participation in any and all activities prepared by Banyan Educational Sevices Inc. during the selected Banyan S.T.E.A.M. Camp. In exchange for the acceptance of said child’s candidacy by Banyan Educational Sevices Inc., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Banyan Educational Sevices Inc. and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against Banyan Educational Sevices Inc., including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports and play activities. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization
the medical facility. Release authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
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
Please select the camp group of your child.

Grade 1 - 3.Grade 4 - 6.Grade 7 - 8 (Jr. Camp Leader).
Thank you for registering your child for Banyan Ed. Steam Camp. You will receive payment instructions via email within 24 hours.
My Products
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Pre-Camp Care Services (8:00 - 9:00am)$75.00 / week.
$75.00CAD Quantity



Post-Camp Care Services (4:00 - 5:00pm)$75.00 / week.
$75.00CAD Quantity



Tutoring (Barton / General Support) 1 hr.
$40.00CAD Quantity



Banyan Ed. STEAM Camp (14th -18th July, 2025)
$450.00CAD Quantity



Banyan Ed. STEAM Camp (21st - 25th July, 2025)
$450.00CAD Quantity



Subtotal

$0.00CAD

Tax

$0.00CAD

Total

$0.00CAD
Should be Empty:

Camper Information

Parent/Guardian Information

Emergency Information

Informed Consent and Acknowledgement

Medical Release and Authorization

Confirmation

Thank you for registering your child for Banyan Ed. Steam Camp. You will receive payment instructions via email within 24 hours.