Vernon Summer Camp 2006

Program location

Vernon, B.C. 3300-27 th Street, Beairsto Childcare Center

Sponsored by the North Okanagan Child Care Society & Montessori Preschool

Phone: 212-7594 - email angela@expression.bc.ca

MAIL Enrolment w/ payment to 1606 30 th St. Vernon, BC V1T 5E8

Child Information
Name:
DOB: Age:

Family Information

Mother:

Work Phone:

Father:

Work Phone:

Home Phone:

Mobile Phone:

Mail Address:

Email Address:

Emergency or Alternative Contact Person
Only the persons on this list are authorized to pick up your child or to be contacted in case of an emergency.

#1) Name

Phone

#2) Name

Phone

#2) Name

Phone

Child Medical Information:

Allergies:

Food requirements:

Other Medical information:

Family Doctor:

Care Card Number:

Medical Authorization:

In the case of a Medical Incident or Illness, we will contact the Parents first, and then the Emergency Contact persons in the order listed on the form. In the case of an Emergency we will contact an ambulance followed by the Parents, then Emergency Contact persons in the order listed on the form.

I___________________________________ understand and agree to the following procedures.

Photo & Video Authorization

I ____________________________ permit my child’s__________________ photo to be taken and posted during the duration of the program and at other related program events.

I _________________________________________declare and accept that all of the information above is current and accurate.

Signed________________________________Date: ______________________________

Program Information

Camp Fee

Age

Dates

Times

140.00$

4-8

August 14-18

9am – 2:00pm

140.00$

7-11

August  22-26

9am – 2:00pm

Payment of __________________included. Check payable c/o Angela Roy