KinderCamp Registration Form

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)

STEP 4: Select number of days per week (ie. 2-Days is Tuesday & Thursday)

*NOTE: Half Day is only available for Toddler and Pre-Nursery ages.
SESSION* If sending for one month, select which

Session 1: Tues. July 4 - Fri. July 28Session 2: Mon. July 31 - Fri. Aug. 25Entire Summer
GRADE*
HALF DAY Only Available Toddler to Nursery

5 Days a Week - One Month3 Days a Week - One Month2 Days a Week - One Month5 Days a Week - Full Summer3 Days a Week - Full Summer2 Days a Week - Full Summer
FULL DAY Pick your schedule

5 Days a Week - One Month3 Days a Week - One Month2 Days a Week - One Month5 Days a Week - Full Summer3 Days a Week - Full Summer2 Days a Week - Full Summer
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)York Region (must still include credit card info)
REGISTRATION FEE: To secure your spot, a $100 non-refundable deposit is required upon registration. This goes towards your total cost.

This does not apply to those receiving York Region Subsidy.