March Break Camp Registration

Camp Registration Form

Please fill out the form to register your child(ren) for our 3 day March Break camp on Tuesday, March 17th to Thursday March, 19th from 9 am-3:30 pm. We will only host a small camp this year, so space is limited to 20-25 children depending on volunteer availability. You will receive a confirmation email from Pastor Tina if your child obtains a space in our program and payment can be sent after you receive the confirmation.
Parent/ Guardian Name*

First NameLast Name
Additional Parent/ Guardian Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail contact*
Phone Number*

Area CodePhone Number
Work Number

Area CodePhone Number
Emergency Contact*

First NameLast NameRelation to Child
Emergency contact Phone Number*

Area CodePhone Number
Who may pick up your child?*

MomDadEmergency ContactOther
Do you attend a church? If so where?*
I give Westview permission to use photos of my child(ren) for church slideshows, newsletter, website, crafts and promotional material. (Please only check one box)*

Yes, I give full photo permissionYes, but no online photosPhotos for kids personal crafts only pleaseNo photos pleaseOther
I give permission for my child to walk to or take a bus to trips throughout the week including the Palasad and another trip TBD. Trip details will be confirmed closer to March Break. Trips are also subject to change depending on weather and unforeseen circumstances. Children should bring their own bagged lunch each day. Payment of $50 (cash, cheque, or e-transfer to payments@westviewbaptist.ca) should be delivered or mailed to Westview Baptist Church within 1 week of registration; 1000 Wonderland Rd S; London, ON; N6K3S4. If payment is not received within 1 week, I understand that my child's space may be given to a child on a waiting list. If I withdraw my child from this program, I understand that a $15 administration fee will be retained.

I have read and agree to the above statement
First Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade
Health Card #
Gender
Allergies or Medical Concerns
Second Child's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Health Card #
Gender
Allergies or Medical Concerns
Third Child's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Health Card #
Gender
Allergies or Medical Concerns
Additional Comments or Questions
Should be Empty:

Camp Registration Form