Camp Registration Form 2017


1. CHILD'S INFO

Child's Name:
Gender: FemaleMale
Birthdate (D/M/Y):
Age:
Medicare Number:
Medicare Expiration Date:
Home Address:


2. PARENT / LEGAL GUARDIAN

Parent's name:
Telephone (cell):
Telephone (home):
Telephone (work):
Email:


3. PARENT / LEGAL GUARDIAN

Parent's name:
Telephone (cell):
Telephone (home):
Telephone (work):
Email:


4. EMERGENCY CONTACTS

1. Name of emergency contact:
Relationship:
Telephone (cell):
Telephone (home):
Telephone (work):

2. Name of another emergency contact:
Relationship:
Telephone (cell):
Telephone (home):
Telephone (work):


SPECIAL NEEDS

Please indicate any special eating habits, allergies, medications, or other.
How can we best support your child's special needs?


Please select your camp(s)

July 3 to 7 - Pottery & Aikido CampJuly 10 to 14 - Freeplay CampJuly 17 to 21 - Survival CampJuly 24 to 28 - Sleepover CampJuly 31 to Aug 4 - D&D CampAug 7 to 11 - Rock Band CampAug 14 to 18 - Math & Sports CampAug 21 to 25 - Aikido Camp


Payment

To reserve your spot, please pay a deposit of $50 per camp.
Please send a cheque to:
Centre Communidée, 137 St-Ferdinand #153, Montreal, H4C 2S6,
or ask us about paying through PayPal.
The balance is due on the first day of camp.


Please read the following conditions carefully

Refund Policy: Refunds will only be issued upon receipt of a written request, prior to the first day of the camp. No reimbursement will be issued for days missed by the participant. A $50 administrative fee will be charged for all refunds issued.

Health Policy: For everyone's well being, the person in charge of Camp Communidée cannot accept a child who is not able to follow the group's daily activities because of an illness (cold, flu, etc). Your child will also not be accepted if they are feverish or contagious.

In case of emergency, Camp Communidée will seek a physician or dentist to treat the participant as needed.

Camp Communidée may use pictures taken during the activities for promotional purposes.


Please check this box to confirm that you have read and agree to the conditions above.

I accept.

We will ask you to sign a paper version of this agreement on the first day of camp.