SUMMER DAY CAMP REGISTRATION 2025

SUMMER DAY CAMP REGISTRATION 2025
PARTICIPANT INFORMATION
Full Name*
Preferred Name
Birth date*

MonthDayYear
Date
School Grade
Home Address*
City*
Province*
Postal Code*
Are you a Nepean School of Music Student?

YesNo
Teacher If Applicable
How did you hear about our day camp?
At the end of each day, my child may leave on their own or until picked up by:*

leave on their ownremain in the Hummingbird Music Limited facilities until picked up by:
1.
or 2.
In any case where an alternative pick-up is arranged, please let us know in writing.
PARENT/GUARDIAN INFORMATION
Full Name*
Home Address*
City*
Province*
Postal Code*
Telephone*
cell
Contact Email*
example@example.com
SECONDARY EMERGENCY CONTACT INFORMATION
Full Name
Relationship to Participant
Telephone: (daytime)
evening
cell
Contact Email
example@example.com
SESSION FEES
Session 1 (July 7th - 11th) (full)
Before/On June 15: $295
After June 15: $325

Session 2 (July 28th – August 1st)
Before/On June 15: $295
After June 15: $325

Session 3 (August 5th – 8th) - shorter week (full)
Before/On June 15: $236
After June 15: $266

Session 4 (August 25th – 29th)
Before/On June 15: $295
After June 15: $325
* A $150 non-refundable deposit is required to register.
You can submit it online now, or contact us to arrange another payment method.
The remaining balance is due by the first day of the program.

*A 10% discount applies for families enrolling more than one child or enrolling in multiple sessions.
HEALTH INFORMATION
*please note: participants should bring a packed lunch and snacks, as food is not provided.
Does your child have any medical or behavioral conditions that we should be aware of?*

YesNo
If yes, please explain
Dietary restrictions
Allergies and severity
Family Physician
Physician Phone Number
Participants Health Card Number:
AUTHORIZATION AND WAIVER
I authorize the participant to travel in conjunction with events associated with this program. I authorize Hummingbird Music Limited or designate to seek any medical attention deemed necessary during my child's participation in this program.
PHOTO / VIDEO PERMISSION

I give permission for photographs or video of the participant to be used for memorabilia or promotional purposes in any media.I do NOT give permission for photographs or video of the participant to be used.
I hereby release Hummingbird Music Limited, its directors, instructors, volunteers and/or affiliates from any claim or action of any kind for damages, loss or injury.
Signature of Parent or Guardian

Clear
Date

MonthDayYear
Date
Start Payment
Are you registering more than one child and/or booking more than one camp session? Families receive a 10% discount when registering multiple children and/or booking multiple sessions. Please complete a separate form and payment for each child.*

Yes, I am registering more than one child or booking multiple sessions.No, just one child and one session.
Which plan you are going to choose?*

Session 2 July 28 – August 1 $325Session 4 August 25 – August 29 $325
Session 1 July 7 – July 11 $325 （full now）

Session 3 August 5 – August 8 $266 （full now）
Price
Discount
HST(#131583924)
Total Price(Before pay $ 150 non-refundable deposit)
Total Price
Would you like to pay now?*

Yes, I’d like to pay the full amount now.I’d like to pay the $150 non-refundable deposit now.No, I’d prefer to discuss alternative payment options with the office.

Transaction Amount

CAD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

SUMMER DAY CAMP REGISTRATION 2025

PARTICIPANT INFORMATION

PARENT/GUARDIAN INFORMATION

SECONDARY EMERGENCY CONTACT INFORMATION

SESSION FEES

HEALTH INFORMATION

AUTHORIZATION AND WAIVER

Start Payment