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
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 |
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