KinderCamp Registration Form - Chabad Lubavitch of Markham

CAMP SESSION* If sending for one month, select which

Session 1: Thurs. July 2 - Fri. July. 31Session 2: Tues. Aug. 4 - Wed. Aug. 26Entire Summer

Start Date* First Day of Camp

Month Day Year

End Date* Last Day of Camp

Month Day Year

Camper*

First Name Last Name

Birth Date*

Month Day Year

Gender*

MaleFemale

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone*

Area Code Phone Number

MOTHER*

First Name Last Name

Cell Number*

Area Code Phone Number

E-mail*

FATHER*

First Name Last Name

Cell Number*

Area Code Phone Number

E-mail

Child's Pediatrician Information (Phone, Address, OHIP, Allergies, etc.)*

Emergency Contact*

First Name Last Name

Phone Number*

Area Code Phone Number

Authorized Pick-up* incl. # and relationship

INSTRUCTIONS

STEP 1: Pick your session

STEP 2: Pick your child's grade

STEP 3: Pick your schedule (either HALF DAY* or FULL DAY)

*NOTE: Half Day is only available for Toddler and Pre-Nursery ages.

*The new CWELCC Fees Subsidy/Grants has been released. We are pleased to inform you that the changes are now reflected in the updated fee information.

GRADE*

SECURITY DEPOSIT* *deductible from monthly fee

$500

HALF DAY Only Available Toddler to Pre-Nursery

5 Days a Week - One Month ($850)5 Days a Week - Full Summer ($1700)

FULL DAY Pick your schedule

5 Days a Week - One Month ($1310)5 Days a Week - Full Summer ($2620)

CAMP T-SHIRT You can use previous ones if you have

Yes Please

Subsidies: We are registered with York Region for fee assistance. To apply, please call 1-888-703-5437. For ages Toddler to Nursery.

Up-to-date Immunization Records are MANDATORY. Please email a copy to kindercamp@chabadmarkham.org or fax to 905-886-0421. This must be submitted before camp in order to be allowed entrance.

Call York Region Community & Health Services Immunization Team at 1-877-794-1880 if you need exemption forms or have any questions.

I hereby give KinderCamp permission to take pictures of my child and publish them online.*

YesNo

Parent/Guardian Name*

First Name Last Name

Date*

Month Day Year

FRIENDS Please indicate up to 3 names of friends your child would like to join for camp. Every effort will be made to accommodate such requests:

For more details and queries regarding our payment processing, we are here to assist you!

Payments will be processed only through the office. Please contact our office at 905-886-0420 ext. 227.

Total

$0.00

BILLING*

Monthly (from now evenly until Aug)Summer (split over July & Aug)All At Once (at time of registration)Child Care Fee Subsidy - York Region (must still include credit card info)

REGISTRATION: To secure your spot, a $500 security deposit is required at the time of registration. This deposit will be deducted from your monthly fee.