March Break Camp Registration

Please call 444-9503 to verify space before sending in your registration.

I, the undersigned parent or guardian of the above-named participant, acknowledge that I am aware that this program involves strenuous physical activity carrying with it various inherent risks of injury which may require medical attention. In my opinion, the above-named participant is medically and physically fit to participate in this program. I hereby grant authority to the staff to render judgement concerning medical assistance in the event of an accident or illness during my absence. I also give consent to my family physician to treat the above-named participant. If my family physician is not available, I give consent to the staff to obtain such medical assistance and treatment as they deem appropriate. If your child has any medical condition, we are not responsible for any situation that may occur relating to the medical condition of this child.

$30 deposit required upon registration. Child's Medicare number is required before they can attend the camp.

Fields in bold are required.

Please check which day(s) your child will be attending:
Date:
Child Name:
Sex	Male Female
Date of Birth
Age:
Address:
Postal Code:
Parent/Guardian:
Work #:
Home #:
Cell #:
Parent/Guardian:
Work #:
Home #:
Cell #:
Emergency Contact (Other than Parents):
Work #:
Home #:
Cell #:
How did you hear about out program?
Name of child's school:
March 2 - 6	Monday Tuesday Wednesday Thursday Friday Full Week
Please indicate any person other than the parents who will be permitted to pick your child up from the centre; we have a sign out system and will not allow the children to leave with anyone not on the list.
Family Physician:
PLEASE INDICATE MEDICAL CONDITIONS, ALLERGIES OR BEHAVIOURAL PROBLEM AREAS:
The above mentioned child, is allowed to have his/her photo taken for possible use in Kingswood promotional materials (print, web).
Email Address:

	March Break Registration Form Or click here to download the March Break registration form to fill it out and drop it off at Kingswood! Download (30 kb)