Summer Camp Detailed Registration Form

Registration Form
Child Information
Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name*

First NameLast Name
Home Number
Mobile Number*
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Alt. Phone Number
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the child prescribed an inhaler? If yes, please explain any instructions.
Select the days you wish to join*

Tuesday 29th July 2025Wednesday 30th July 2025Thursday 31st July 2025Tuesday 05th August 2025Wednesday 06th August 2025Thursday 07th August 2025Tuesday 12th August 2025Wednesday 13th August 2025Thursday 14th August 2025Tuesday 19th August 2025Wednesday 20th August 2025Thursday 21st August 2025Tuesday 26th August 2025Wednesday 27th August 2025Thursday 28th August 2025
Confirmation

Once we receive your completed registration, we will issue an invoice for payment. Please note that all fees must be paid in advance of the class start date and are non-refundable in the event of absence.
Date

MonthDayYear
Date
Signature

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Registration Form