Summer Kids Computer Day Camp 2009

           The QUEST Centre Registration Form: Registration deadline: One week before session starts  

 

 

Child’s First Name

Child’s Last Name

Gender

Grade

Age

Date of Birth

mm  dd  yy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  Session 1   July 13-17                      5 Countries In 5 Days
  Session 2   July 20-24                     Flashback 
  Session 3   July 27-31                     Sports & Leisure
  Session 4   August 4-7                    Mad Science 
  Session 5   August 10-14                Arts Week

Session 1, 2, 3, & 5: $140/ wk/child                Family Rate: Multiple weeks or each additional child: $115/week
Session 4: $115/wk/child                                 Family Rate: Multiple weeks or each additional child: $90/week

Children are required to bring a lunch and a drink except on Fridays when lunch is provided

The Summer Kid’s Camp will provide light snacks and indoor/outdoor activities with a focus on computer fun.

 

Mother/Guardian’s Name:_____________________Phone #: Home___________________ Work______________________

 

______________________________________________________________________________________________________________

Address                                                                                                                     City/Town                        Postal Code

 

Father/Guardian’s Name:______________________Phone #: Home_______________________Work__________________

 

______________________________________________________________________________________________________________                                                        Address                                                                                                                       City/Town                                              Postal Code

 

If parents cannot be reached, additional people your child(ren) may be released to:

1. Name_________________________________________________            Phone # ________________________________

 

2. Name_________________________________________________            Phone # ________________________________

In case of emergency, if parents cannot be reached, who can we contact?

1. Name_________________________________________________            Phone # ________________________________

 

2. Name_________________________________________________            Phone # _______________________________

 

Name of Family Doctor   _______________________ Phone # ___________________  OHIP # ______________________

 

Does your child have any allergies?  Yes / No   If  yes, please list___________________________________________

 

Are there any medical/physical conditions?   Yes / No     If yes, please explain_____________________________________

 

Are there any special requirements?  Yes / No               If yes, please explain______________________________________

 

I hereby give my permission for my child(ren) to be treated by a physician or hospital staff member should there be an accident, sudden illness or emergency.         Yes / No

 

Parent/Guardian Signature:   ________________________________________     Date:________________________

 

* To ensure safety and fun for all, the director of the program reserves the right to withdraw anyone from the program who destroys public property, injures another participant, or refuses to cooperate with the camp leader.