Use this form to register in summer camp. If you have questions, phone the school or email the principal, Gail Hooper, at firstname.lastname@example.org Child's Last Name Child's First Name Date of Birth (Please use 0000-00-00 format, yr-mo-da, all others will NOT work) Health Card Number Current Grade Street Address City Postal Code Home Phone Number Family Email Address Will you be requiring Before and After Care? YesNo If Before and After is required what days and times (**also if there is a different person picking up a password and ID are needed**). Mother's Full Name If information is different than above then please fill out. Mother's Street Address Mother's City Mother's Postal Code Mother's Home Phone Number Mother's Work Phone Number Mother's Cellular Number Father's Full Name If information is different than above then please fill out. Father's Street Address Father's City Father's Postal Code Father's Home Phone Number Father's Work Phone Number Father's Cellular Number Child's Doctor's Name Child's Doctor's Phone Medical Information (please include allergies and other pertinent information) Emergency Contact # Emergency Contact Name Please check the theme weeks to sign up for the weeks you are most interested in. Our themes and weeks change each year so make sure you check the website information. 1. Viking Week - July 4th to 7th (July 3rd is a statutory holiday) 2. Cooking Week - July 10th to 14th 3. Reptiles and Bugs- July 17th to 21st 4. Sports Week- July 24th to July 28th 5. Rocketry Week - July 31st to August 4th 6. Under the Sea - August 8th to August 12th (August 7th is a holiday) 7. Weird Science - August 14th to August 18th 8. Survivor Week - Aug 21st to 25th Weeks selected (please indicate the week(s) you are signing up for by adding the week #(s) in this box): ***With the enrolling of my child at Hillcrest Private School Summer Camp a $50 deposit for each week enrolled is required to finalize the registration and hold your child(s) spot. There are ONLY 40 spots available for each week!!*** Permission Any expenses incurred for any kind of medical attention, will be borne by the child's family. Hillcrest will not be responsible for anything that may happen as a result of false information given at the time of enrollment. I hereby grant permission for my child to use all of the play equipment and participate in all the activities of the Summer Day Camp. I hereby grant permission for my child to leave the Hillcrest premises under the supervision of a staff member for neighbourhood walks or for field trips in an authorized vehicle. I hereby grant permission for my child to be included in all games and activities with all the other children and will not hold the Hillcrest responsible for any injuries that may occur from these activities. I hereby grant permission for the person in charge that day to take whatever steps may be necessary to obtain emergency medical care if warranted. If we cannot contact you or your child's physician we will do any or all of the following: 1) Call another physician or paramedics. 2) Call an ambulance. 3) Have the child taken to an emergency hospital in the company of a staff member. PLEASE READ CAREFULLY **With the enrolling of my child at Hillcrest Private School Summer Camp, I will pay a $50 deposit for each week my child is enrolled and fulfill my financial obligation so my child is allowed to participate in the Hillcrest Summer Day Camp. There is a 2% interest charge on all outstanding account balances and a $35 service charge for any returned cheques. Families who have outstanding balances will be asked to leave the Summer Day Camp and will not return until their accounts are in good standing. I agree to the above statements *Form will NOT submit unless you click box to agree* Please enter code above (this is just to prove you are human) SIGNED: __________________________DATE:_______________________ ****If this form is not "submitting" then you may have not filled in all the required information above.**** Filling out this form DOES NOT fully register your child(ren) for Hillcrest Summer Day Camp. A deposit of $50 for each week and child is required to complete the registration and hold your spot in the day camp week(s).