Clone of Summer Camp Waitlist

KPAC/KCCC Summer Camp Waitlist Form

All forms will be reviewed by the daycare manager, and a confirmation email will be sent prior to enrolment. Completion of the form does not guarantee a space. Camp for Ages: 5 to 12 years old (must have completed Kindergarten)
Full-Time & Part-Time Options Available: 5 days - $200/week or $40/day

Registration Deposit Will Be Required Upon Successful Registration & Invoicing.

PRE-REGISTRATION is required, no drop in services will be offered.
Childs Name

First NameMiddle InitialLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 1 (Authorized to Pick-Up)

First/Last NameFirst/Last Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
E-mail
example@example.com
Parent/Guardian 2 (Authorized to Pick-Up) (optional)

First/Last NameFirst/Last Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
E-mail
example@example.com
Emergency Contact (Authorized to pick-up)

First NameLast Name
Mobile Number
Format: (000) 000-0000.
Additional Person Authorized to pick up (optional):

First/Last NameFirst/Last Name
Additional Person Authorized to pick up (optional):

First/Last NameFirst/Last Name
Does your child have any allergies, medical conditions, or support needs we need to be aware of?

Photo of Participant

Please upload a clear and recent photo of your child
Cancelof
Terms of Agreement
Photo/Video Waiver - I the undersigned, authorize the KPAC and KCCC to use any photo/video of my child taken during class time to be used to market and promote the KPAC or KCCC in printed or other media publications, including but not limited to Facebook, City of Dawson Creek Leisure Guide, brochures and/or websites.
Required Consent

Please check boxes to confirm you have read, understand, and consent to the statements below.
Parent's Commitment - I have discussed with my child and confirm they agree to participate in the summer camp program, including walks/field trips, to follow safety instructions and/or refrain from behavior that is harmful to themselves or others. I understand that abusive behavior displayed by my child is cause for dismissal without refunded fees.
Field Trips - In permitting my child to attend the KPAC/KCCC Summer Camp, I, the initialed, permit my child to participate on various field trips. These may include local trips via walking, or on planned outings that will be communicated with parents before the day camps begin.
Release of Liability - I release and discharge any and all rights and claims for damages of suit or action that my child may have at any time against the Kiwanis Performing Arts Centre or the Kiwanis Child Care Centre, along with all employees and for any and all injuries suffered by my child as a result of participating in our Summer Camp. KPAC/KCCC is not responsible for any lost or damaged personal items.
I, the undersigned, hereby certify that all the information provided is true and correct to the best of my knowledge and belief.

KPAC/KCCC Summer Camp Waitlist Form

Terms of Agreement

Required Consent

Weekly Registration