Summer Camp - Registration Form

Student's Name*

First NameLast Name

Birth Date*

MonthDayYear

Health card number*

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

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Alt. Phone Number

Format: (000) 000-0000.

Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.*

Week 1 June 29 - July 3 Discover Canada - $310Week 2 July 6- July 10 Nature Explorers- $385Week 3 July 13-July 17 Dinosaur Discovery - $385Week 4 July 20- July 24 Garden Explorers - $385Week 5 July 27-July 31 All Around the World - $385Week 6 August 4- August 7 Under the Sea - $310Week 7 August 10-August 14 Space is the Place - $385Week 8 August 17- August 21 Rainforest Travels - $385

Risk Waiver

The risk of injury exists in every athletic activity. Falls, collisions and other incidents may occur and cause injury. Due to the very nature of athletic activities and outdoor play, injuries may range from minor sprains and strains to more serious injuries including the head, neck or back. Some injuries may lead to paralysis or prove to be life threatening. These injuries result from the nature of athletic activities and can occur without any fault on either the part of the student, Rotherglen School, its employees/agents. By choosing to particpate in outdoor play/activity you are assuming the risk of injury happening. The chances of injury occurring can be reduced by carefully following instructions at all times while engaged in athletic activity. Rotherglen School attempts to manage as effectively as possible the risk for students while participating in sports/athletics/outdoor play. I the undersigned, agree that Rotherglen School, its employees, or agents shall not be liable for any accident or injury sustained by my child(ren) or for any loss or damage to personal property arising from, or in any way resulting from, participation in this program.

Summer Camp Refund Policy

For June and July Camp Sessions:
100% refund if cancelled by May 26, 2026
50% refund if cancelled by June 12, 2026

No refunds will be issued for cancellation requests received after June 22.

For August Camp Sessions:
100% refund if cancelled by June 29, 2026
50% refund if cancelled by July 10, 2026

No refunds will be issued for cancellation requests received after July 13, 2026

Please note:

Refunds will not be provided for days of camp not attended.
Rotherglen School will do everything possible to avoid program cancellations.
However, if enrollment for a session is low, we reserve the right to cancel the session.
In such cases, we will offer:
- Placement in an alternate program/week or a full refund.

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

Signature

Summer Camp Registration

Student Information