KinderCamp Registration Form

CAMP SESSION* If sending for one month, select which

Session 1: Wed. July 2 - Fri. July 25Session 2: Mon. July 28 - Fri. Aug. 22Entire 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

$100
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 [email protected] 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:
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 $100 security deposit is required at the time of registration. This deposit will be deducted from your monthly fee.

Payment*

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Credit Card

We accept Visa, MasterCard
Credit Card Number
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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