PARENT / GUARDIAN INFORMATION Parent First & Last name (required) Your Email (required) Confirm e-mail (required) Address including Suffix, Street, City, Province Postal code. (required) Home Telephone (required) Cellular (required* Please write NO for none* ) EMERGENCY CONTACT Emergency Contact Name (required) Relationship (required) Emergency Contact Telephone 1 (required) Emergency Contact Telephone 2 ( Please write NO for none* ) BUY MORE, SAVE MORE OPTIONS number of sessions you are purchasing 4 sessions: $2,0003 sessions: $1,7002 sessions: $1,200 E-TransferCheque or money order MULTIPLE SIBLING REGISTRATION CAMPER 1 INFORMATION First & Last name Medicare , In-case of emergency Age (how old they will be when camp begins) —8910111213 Any allergies or medical conditions we should know about? (specify) * Please write NO for none* Please select which session(s) Camper 1 will attend Session 1: June 25 -July 5Session 2: July 8 -July 19Session 4: August 5-16 Choose your extended care Options(Leave blank for none) Session 1: Pre-Camp, Add $30 to your totalSession 1: After-Camp, Add $60 to your totalSession 1: Pre & After Camp, Add $90 to your totalSession 2: Pre-Camp, Add $30 to your totalSession 2: After-Camp, Add $60 to your totalSession 2: Pre & After Camp, Add $90 to your totalSession 4: Pre-Camp, Add $30 to your totalSession 4: After-Camp, Add $60 to your totalSession 4: Pre & After Camp, Add $90 to your total CAMPER 2 INFORMATION First & Last name Medicare , In-case of emergency Age (how old they will be when camp begins) —8910111213 Any allergies or medical conditions we should know about? (specify) * Please write NO for none* Please select which session(s) Camper 2 will attend Session 1: June 25 -July 5Session 2: July 8 -July 19Session 4: August 5-16 Choose your extended care Options(Leave blank for none) Session 1: Pre-Camp, Add $30 to your totalSession 1: After-Camp, Add $60 to your totalSession 1: Pre & After Camp, Add $90 to your totalSession 2: Pre-Camp, Add $30 to your totalSession 2: After-Camp, Add $60 to your totalSession 2: Pre & After Camp, Add $90 to your totalSession 4: Pre-Camp, Add $30 to your totalSession 4: After-Camp, Add $60 to your totalSession 4: Pre & After Camp, Add $90 to your total CAMPER 3 INFORMATION (If applicable / leave blank for no) First & Last name Medicare , In-case of emergency Age (how old they will be when camp begins) —8910111213 Any allergies or medical conditions we should know about? (specify) * Please write NO for none* Please select which session(s) Camper 3 will attend Session 1: June 25 -July 5Session 2: July 8 -July 19Session 4: August 5-16 Choose your extended care Options(Leave blank for none) Session 1: Pre-Camp, Add $30 to your totalSession 1: After-Camp, Add $60 to your totalSession 1: Pre & After Camp, Add $90 to your totalSession 2: Pre-Camp, Add $30 to your totalSession 2: After-Camp, Add $60 to your totalSession 2: Pre & After Camp, Add $90 to your totalSession 4: Pre-Camp, Add $30 to your totalSession 4: After-Camp, Add $60 to your totalSession 4: Pre & After Camp, Add $90 to your total CAMPER 4 INFORMATION (If applicable / leave blank for no) First & Last name Medicare , In-case of emergency Age (how old they will be when camp begins) —8910111213 Any allergies or medical conditions we should know about? (specify) * Please write NO for none* Please select which session(s) Camper 4 will attend Session 1: June 25 -July 5Session 2: July 8 -July 19Session 4: August 5-16 Choose your extended care Options(Leave blank for none) Session 1: Pre-Camp, Add $30 to your totalSession 1: After-Camp, Add $60 to your totalSession 1: Pre & After Camp, Add $90 to your totalSession 2: Pre-Camp, Add $30 to your totalSession 2: After-Camp, Add $60 to your totalSession 2: Pre & After Camp, Add $90 to your totalSession 4: Pre-Camp, Add $30 to your totalSession 4: After-Camp, Add $60 to your totalSession 4: Pre & After Camp, Add $90 to your total 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/Creative Video Day Camp, 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/Creative Video Day Camp to use all pictures and videos across all media platforms, present and future. A registration must be accompanied by a full payment. The EARLY BIRD DISCOUNT applies to those who register by the specified dates (registered by April 8, 20234). Camp hours are from 9am-4pm. I understand that I will be charged $1.00 for each minute after closing beginning at 4.05pm. Late fees are assessed regardless of circumstances and are to be paid directly to the teacher on duty at time of pick up. Initial deposit fee of $50.00 per session is non-refundable. If a cancellation is made one month or more prior to the start of the camp session, 100% of fee (minus $50.00 per session) will be refunded. If a cancellation is made within one month or less to the start of the camp, 85% of fee will be refunded. Once the camp has started: NO REFUND will be issued. All cheques returned “Non-Sufficient Funds” will carry a $50.00 service charge. Do you agree to the terms and conditions? YES How did you hear about us? If you were referred by someone please enter their name here.(required) Δ
