Summer Camp Registration Form

Summer Camp Registration Form

9 am-3pm. 299 Lakeshore Dr, Unit 001, Barrie
Weeks

July 6-9. July 13-16. July 20-23 July 27-30. August 10-13. August 17-20
Pricing

2 Days $150 3 Days $225 4 Days $300
Camper's Information

Please fill out the following information for your child.
Child's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does your child have any medical conditions or allergies that the school should be aware of?
Parent / Guardian #1 Information

(All correspondence and and invoices will be sent to this person)
# 1 Name

First NameLast Name
#1 Email
example@example.com
Phone Number

Area CodePhone Number
Relationship with the Child
Parent/Guardian #2 Information
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Relationship with the Child
Emergency Contacts and Authorized Pick Up Persons
Learning Preferences

Please fill out the following questions so we can learn more about your child!
Does your child have any learning preferences, diagnosis or behavioural difficulties?
Please share with us some of your child’s favorite/least favorite things about school (if attended) or with learning in general:
What would you like to see your child get out of participating in the program?
If there anything else you would like to share or that you think we should know about your child please share it here:

Rows	Yes, my childs image may be used	Yes, with conditions. My child’s face must be hidden (back of head only)	Yes, with conditions. My child’s face must be hidden (face covered with a sticker)	No, My childs image may not be used
Facebook
Instagram
Brookstone Website
Flyers or Digital Ad

Parent/Guardian #2 Information