Heart and Play Summer Camp Enrollment Form
Camper's Information
Camper's Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Camper's Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Camper's Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please indicate which camp you would like your child to join.
Unicorn & Rainbow Magic Summer Camp Week 1
🦸♀️Super Hero Squad Summer Camp Week 2🦸♂️
🦄Fairytale Forest Summer Camp Week 3🌳
🦖Dinosaur Discovery Summer Camp Week 5 🌋
🚀Space Explorers Summer Camp Week 4🌌
Camper's Photo (Optional)
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Parent/Guardian Information
The parents/guardian listed below will be the authorized person to pick-up the child after the camp.
The parents/guardian listed below will also be the primary emergency contact person.
Name
First Name
Last Name
Relation
Phone Number
-
Area Code
Phone Number
Picture upload
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Name
First Name
Last Name
Relation
Phone Number
-
Area Code
Phone Number
Picture upload
Browse Files
Cancel
of
Medical Information
Does the child have any allergies? If yes, please list them below:
Does the child have any previous injuries? If yes, please explain them below:
Does the child have any current medical conditions? If yes, please list them below:
Does the child takes any medication? If yes, please list them below and explain its purpose:
Payment Details
Method of Payment
Please Select
Cash
Credit Card
E-Transfer
Authorization
I, the parent/guardian of this camper gives authority to the staff of this camp to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if the emergency contact person cannot be reached. I authorized first aid, medical/surgical diagnosis, and treatment which may deem necessary.
I released the organizers, coaches, staff, or managers of this camp for any responsibility in case of accident, illness, or injury during my child's enrollment.
I confirm that all information given in this form is true, complete, and accurate.
Parent/Guardian Signature
My Products
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( X )
One Week
$
265.00
CAD
Register for one week and 1 camper only
Campers
1
2
3
4
5
6
7
8
9
10
Two Weeks
$
530.00
CAD
Register for two 1 camper 1 weeks only
Campers
1
2
3
4
5
6
7
8
9
10
Three Weeks
$
795.00
CAD
Register for three weeks 1 camper only
Camper
1
2
3
4
5
6
7
8
9
10
Total
$
0.00
CAD
Submit
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