Summer Day Camp Registration Form 2026

Summer Day Camp Registration Form

Please fill out the form to register your child for the summer day camp. Ensure all required fields are completed.
Child's Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child's Date of Birth

MonthDayYear
Date
Parent/Guardian

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Select Days Attending
Weeks Attending
Select Session Type
If Registering for Day to Day
Does your child have any allergies?
Please specify allergies if any
Are there any special medical or behavioral considerations?
Please specify any medical or behavioral considerations
Health Card Number
Emergency Contact Name

First NameLast Name
Emergency Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Terms & Conditions

Camper Conduct and Safety The safety and well-being of all campers and staff is our highest priority. If a camper exhibits behavior that is dangerous to themselves, to others, or is otherwise severely disruptive, we reserve the right to dismiss the camper from the program at our sole discretion. In such cases, no refund will be issued for any portion of the camp program missed due to dismissal. Parents or guardians will be responsible for arranging and covering the cost of the camper's immediate return home.
Signature
Date

MonthDayYear
Date
Payment Information for Camp Registration

E-Transfers can be sent to bookings@peakvelocitysc.ca.

Cash payments can be made at one of the following locations:

Allstars – 588 Main St., Glace Bay
Monday to Friday, 8:30 AM – 4:00 PM
Peak Velocity – 274 Washplant Road
Monday to Friday, 4:00 PM – 8:00 PM

Please Note:
Registrations are not confirmed until a $30 non-refundable deposit is received.
Full payment is required at least 14 days prior to the start of the selected camp.
Should be Empty: