CAMP TALK-A-LOT 2016

 

CAMPER NAME ___________________________________

 

BIRTHDATE ____________________________ 

 

PRESENT GRADE LEVEL_____________       M      OR      F

 

PARENTS _________________________________________________

 

HOME PHONE_______________WORK PHONE_________________

 

MAILING ADDRESS ___________________________________________

 

CELL PHONE_____________EMAIL ______________________________

 

FAMILY PHYSICIAN __________________PHONE___________________

 

WHO SHOULD WE CONTACT IN CASE OF EMERGENGY?

 

NAME _____________________________PHONE_____________________

 

 ANY SPECIAL NEEDS, ALLERGIES, DIET RESTRICTIONS?

 

________________________________________________________________________________


FOR YOUR CHILD TO BE ELIGIBLE FOR THE PRESCHOOL SESSION HE/SHE MUST BE FOUR YEARS OLD BY MAY 31, 2016

REGISTRATION FEE ENCLOSED _______________

I GIVE MY PERMISSION TO:

  • Attend these sessions and allow Don Mills Achievement Center to us my child's photograph for publicity purposes in all forms of media, including Facebook.
  • It is my understanding that precautions will be taken to avoid accidents and my child will be supervised. In the event of an accident, THE AGENCY WILL NOT BE DEEMED RESPONSIBLE.

I HAVE READ THE ABOVE POLICIES REGARDING CAMP ACTIVITIES, PUBLICITY AND INSURANCE PROCEDURES AND I AM IN AGREEMENT AS STATED.

 

Signature____________________________________________________________________Date_________________________________________________________