Summer Camp Registration 2026

Summer Camp Registration

Xtreme Performing Arts Academy & Xtreme Talent Dance Company
Student Information

One form per child
Child Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Please Attach a Picture (Waist up), of your child. *

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Approximate AM Drop-Off Time- Center Opens at 7am (for Camp Only write 10am)*
My Child will have just finished Grade:*
Medical Information
Child's Family Doctor*

NamePhone Number
Child's Care Card Number*
Immunizations*
Allergies (Indicate N/A if not Applicable)*
Please Indicate All Ingested & Environmental Allergies
Allergy Treatment
Please Indicate Treatment for Allergy (If Needed)
Is Your Child on Regular Medications?*
If Yes - Please Indicate What Medication & What Medical Condition Is Being Treated.
Medication, Care Plans and Special Needs

If your child is on medication that requires staff of Xtreme Performing Arts to administer during childcare hours, you will need to sign a Care Plan/Medication Administration Form. All Medications must be in the original packaging and have the child's name listed.
Does your child Need Medication During Care?*

YesNo
Additional Student Information
Are There Any Foods You Do Not Want your Child to Eat? *
Please list and describe any concerns you may have regarding your Child's Development.*
Does your Child have any Special Needs or Behaviours to be aware of? If Yes, Please Indicate any specific care instructions needed.*
Additional Comments

Family Information
Child Resides *
Parent/Guardian 1 Information*

First NameLast Name
Address*

Street Address

Unit/Suite

CityProvince

Postal Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
E-Mail*
Workplace*
Workplace Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 Information-If not Applicable please put N/A in All Fields*

First NameLast Name
Address*

Street Address

Unit/Suite

CityProvince

Postal Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
E-Mail
Workplace
Workplace Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Additional Authorized Pick-Up / Emergency Contacts

Your #1 will Also be used as your Emergency Contact
#1 Name*

First NameLast Name
Relationship To Student*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
#2 Name

First NameLast Name
Relationship To Student
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
People NOT PERMITTED to Pick-Up

*Please Note: Without a Court Order on file, we are unable to enforce
Name

First NameLast Name
Relationship To Student
Name

First NameLast Name
Relationship To Student
Court Order/Documents Upload

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Custody & Family/Court Orders
Do You have Any Custody or Family Orders in Place? If Yes, Please Supply a Copy.

YesNo
File Upload

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Media Consent

We regularly take photos and showcase our children on social media, studio posters and advertising outlets. We do need your consent to do this, and if you don't want us too - that's fine!
Do you consent to photos being taken and shared of your child?*

Summer Camp Registration