City View Centre for Child  and Family Services

SUMMER CAMP REGISTRATION

Please complete the following information and submit by clicking the “submit” button provided.  Your completed application will then go into our data base waiting list.  Should a space become available we will contact you.  If you require assistance completing this form please do not hesitate to contact us.  Registration can be made by phone, fax or submitting this online form.  Thank you for considering our program for your children’s day care needs.

PARENT'S FIRST NAME:
LAST NAME:
ADDRESS:
POSTAL CODE:
HOME PHONE:
WORK PHONE:
CELL OR OTHER:
EMAIL ADDRESS:

1st Child's Name:
Birth Date: (dd/mm/yy): 
Does you child have allergies,
medical conditions, or any special needs:		 YES      NO   
If yes please describe
Is this child presently on any medications? YES    NO 
If yes, please describe and give details
Can this child swim? YES    NO     
If yes, describe your child's ability in swimming
2nd Child's Name:
Birth Date: (dd/mm/yy): 
Does you child have allergies,
medical conditions, or any special needs:		 YES      NO   
If yes please describe
Is this child presently on any medications? YES    NO 
If yes, please describe and give details
Can this child swim? YES    NO 
If yes, describe your child's ability in swimming
3rd Child's Name:
Birth Date: (dd/mm/yy): 
Does you child have allergies,
medical conditions, or any special needs:		 YES      NO   
If yes Please Describe
Is this child presently on any medications? YES    NO   
If yes, please describe and give details
Can this child swim? YES    NO 
If yes, describe your child's ability in swimming

Please indicate the date or time in which your children will be attending our Summer Camp Program:
Please indicate where you have slated holiday days (in which the child will be away) during the period of time in Summer Camp which you have selected. Please give dates of holidays:
Do you require a subsidy space at our Summer Camp Program? Yes     No  
If you have indicated "No" please be aware that our daily rate for our Summer Camp Program is ___ per day  
* Please note that you are required to pay this daily rate for holidays, applicable statutory holidays and whenever you child is absent sick.  
Please List any other concerns you have which may assist us to provide the best possible experience for your children this summer:
   

 

Thank you for registering your child/ren in our Summer Camp program. Someone will be contacting you soon.

 

                                                                      

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Copyright © 2002 [Centre for Child and Family Services]. All rights reserved.
Revised: February 26, 2003