The Village Shul Summer Camp 2021 - Form

Welcome to The Village Shul Summer Camp 2021 program. Please read the following conditions of enrollment carefully.

Space in the program is limited. Admittance to the program is on a first come first serve basis.
If your application is received after all spaces have been filled your child will be placed on our waiting list and we will notify you to this effect.
The registration form must be filled out completely and signed as indicated. A separate form must be completed for each child.
Full payment must accompany this application.
A copy of the application will be emailed to you upon submission for your records.

* Please select how many weeks you are registering for:

* Which weeks would you like to register for:

July 5-9July 12-16July 19-23July 26-30

* Child's First Name

* Child's Family Name

* Child's Date of Birth

* Child's OHIP Number

Child's Doctor

Doctor's Phone

Doctor's Address

* Does your child have any allergies

Other Allergies:

* Does your child have any special medical, diet, or rest information/requirements.

Please privode all medical, diet and rest details here.

How many Adults are on this account

Adult 1 - First Name

Adult 1 - Last Name

Adult 1 - Cell Phone

Adult 1 - Work Phone

Adult 1 - Email Address

Home Address

Home City

Home Postal Code

* Marital Status

Adult 2 - First Name

Adult 2 - Last Name

Adult 2 - Cell Phone

Adult 2 - Work Phone

Adult 2 - Email Address

* Does Adult 2 live at the same address?

Adult 2 - Home Address

Adult 2 - Home City

Adult 2 - Home Postal Code

Please list 2 emergency contacts in case Parents cannot be reached.

* First Name

Last Name

Relationship to Child

Cell Phone

Address

City

Postal Code

First Name

Last Name

Relationship to Child

Cell Phone

Address

City

Postal Code

Adult 1 - First and Last Name

Adult 2 - First and Last Name

Adult 3 - First and Last Name

Your camp Tuition is due in full now. Payment must be arranged online, upon submission of this form.
If you withdraw your child prior to May 1, 2020, your full payment will be returned to you. If you withdraw your child from May 1, 2020 and prior to May 31, 2020, you will receive a refund minus $250. If you withdraw your child after May 31, 2020, the full payment is forfeit.
Fees are non-transferable.

I have read, understood, and agree to the above conditions of enrolment and confirm the truth and accuracy of all information provided in this application form (except in the case of a single parent family, both parents must sign the application form).

* Parent #1 Name

Date

Parent #2 Name

Date

Total