514.808.9053
info@collectivevision.ca

Creative Video Multiple Registration

PARENT / GUARDIAN INFORMATION

Parent First & Last name (required)

Your Email (required)

Confirm e-mail (required)

Street Address (required)

City (required)

Province (required)

Postal Code (required)

Home Telephone (required)

Work Telephone (required* Please write NO for none* )

Cellular (required* Please write NO for none* )

EMERGENCY CONTACT (If we cannot reach you)

Emergency Contact Name (required)

Relationship (required)

Emergency Contact Telephone 1 (required)

Emergency Contact Telephone 2 (required* Please write NO for none* )

CAMPERS' INFORMATION

Please specify who will be attending camp:

CHILD ONE

Child First & Last name (required)

Age (required)

Medicare , In-case of emergency (required)

Any allergies or medical conditions we should know about? (specify) * Please write NO for none* (required)

Please select your session(s)
SESSION 1 June 26 to July 7, 2017SESSION 3 July 24 to August 4, 2017SESSION 4 August 7 to August 18, 2017

Select your aftercare needs
Pre CampAfter CampNone

CHILD TWO (If applicable)

Child First & Last name (required)

Age (required)

Medicare , In-case of emergency (required)

Any allergies or medical conditions we should know about? (specify) * Please write NO for none* (required)

Please select your session(s)
SESSION 1 June 26 to July 7, 2017SESSION 2 July 10 to 21, 2017SESSION 3 July 24 to August 4, 2017SESSION 4 August 7 to August 18, 2017

Select your aftercare needs
Pre CampAfter CampNone

CHILD THREE (If applicable)

Child First & Last name (required)

Age (required)

Medicare , In-case of emergency (required)

Any allergies or medical conditions we should know about? (specify) * Please write NO for none* (required)

Please select your session(s)
SESSION 1 June 26 to July 7, 2017SESSION 2 July 10 to 21, 2017SESSION 3 July 24 to August 4, 2017SESSION 4 August 7 to August 18, 2017

Select your aftercare needs
Pre CampAfter CampNone

CHILD FOUR (If applicable)

Child First & Last name (required)

Age (required)

Medicare , In-case of emergency (required)

Any allergies or medical conditions we should know about? (specify) * Please write NO for none* (required)

Please select your session(s)
SESSION 1 June 26 to July 7, 2017SESSION 2 July 10 to 21, 2017SESSION 3 July 24 to August 4, 2017SESSION 4 August 7 to August 18, 2017

Select your aftercare needs
Pre CampAfter CampNone

TERMS AND CONDITIONS

I give permission to the animators of Creative Video Day Camp to make any decisions regarding the well being of my child(ren). I give permission for my child(ren) to go to the park with the group. I will not hold Coop Collective Vision/Cooperative Creative Video, Concordia University,or the Concordia Student Union responsible for any injuries or for any and all claims of loss and damage to property that may occur. I agree to allow Coop Collective Vision/Cooperative Creative Video to use all pictures and videos across all media platforms, present and future. A registration must be accompanied by a full payment. I understand that there is a 50% cancellation fee which will not be refunded for any reason (ie. illness, change of plans, etc.). The multiple sessions registrations are for same family/household children.The EARLY BIRD DISCOUNT applies to those who register by the specified dates (registered by April 15, 2017). Camp hours are 9am-4pm, pre and after camp extended hours are extra.

Do you agree to the terms and conditions?

Please select your method of payment

How did you hear about us? If you were referred by a person or website, please specify.(required)