summer collage

SUMMER CAMP REGISTRATION 

    FAMILY INFORMATION

    Campers First Name(required): Campers Last Name(required):
    MaleFemale
    Address(required): City(required):
    Postal Code(required): Email Address(for camp info):
    Date of Birth(required):
    School(required):,

    Grade completed in June 2022(required):
    Home Phone Number:
    Parent's Name(required):
    Work #: Cell #(required):
    2nd Parent's Name:
    Work #: Cell #:
    Parent's Marital Status(required):
    If divorced/separated, camper lives with:
    Parent 1(name): Parent 2(name):
    Name of step parents if re-married:
    Parent 1(name): Parent 2(name):
    Are there any restrictions on either parents access/custody?
    If yes, please email a note with details.

    CAMP DATES (minimum registration of 3 consecutive weeks)

    We know that making summer plans at this time can be difficult, therefore the dates you choose can be changed without penalty if available. This applies only to the dates you have chosen NOT the number of weeks. Please note: CAMP IS OPEN ON JULY 1ST
    PROGRAMS OFFERED:
    Mini Khaos (4 -5yrs old): 215$ per week + swim/field trip option add an extra 55$ per week
    Junior Khaos (6 - 11yrs old): 255$ per week
    Advanced Khaos CIT Program Level 1(12-13yrs): 210$ per week
    Advanced Khaos CIT Program Level 2(14-15yrs): 180$ per week
    Total Number of weeks registering for(required):
    Weeks needed(required):
    Program registering for(required):
    Name of 1 Friend for your child to be grouped with (Friend must be the same age between Oct 1-Sept 30):

    EMERGENCY CONTACT INFORMATION (if any person above cannot be reached)

    Name(other than parent)(required): Phone Number(required):
    Relationship to camper(required):
    CAMPER MEDICAL INFORMATION (A separate camper health form will be sent to be filled out prior to the start of camp)

    Camper Medicare Number(required): Expiry Date(required):
    Pediatrician Name(required): Phone #(required):
    Allergies:
    Other Medical Info (please include any delays, autism or other):
    EXTENDED DAY SERVICES

    We will be happy to help you organize babysitting with our staff at an additional fee. Please indicate the days and times needed.
    7:30-9:00am:
    Weeks and days needed:
    4:00-5:45pm:
    Weeks and days needed:

    CAMP FEES

    When filling out the camp fees below please enter 0 where not applicable.

    ***MULTI WEEK DISCOUNT NOT AVAILABLE FOR LEVEL 2 CIT***
    ****SIBLING DISCOUNT VALID ON THE PROGRAM FEE LESS MULTI WEEK DISCOUNT****

    Mini Khaos (4 -5yrs old): 215$ per week + swim/field trip option add an extra 55$ per week
    Junior Khaos (6 - 11yrs old): 255$ per week
    Advanced Khaos CIT Program Level 1(12-13yrs): 210$ per week
    Advanced Khaos CIT Program Level 2(14-15yrs): 180$ per week

    Fee(Program Fee): Number of weeks registered::
    Discount:(CHOOSE 1): 4 week discount total of 20$, 8 week discount total of 80$
    3rd sibling discount 5%: T-shirt 9$ per shirt (mandatory for field trips):
    Swim/Field trip option for 4-5 year olds
    (please enter 55$ here, total will automatically reflect the number of weeks registered for):
    Optional overnight at YCC Week 3 (1 night – July 14-15 95$) Week 6 (2 nights – August 3-5 150$)
    (if not applicable please enter 0, if taking both overnights please type in 245$):
    Balance owed:

    Please enclose a non-refundable deposit (current date) of $200.00. Preferred payment is E-Transfer(campkhaos@yahoo.com) however we also accept cheques. For Etransfer please use your oldest child's first name as the security answer. The LATEST balance of final E-Transfer or post dated cheque date is JUNE 3rd, 2022.

    MAKE ALL CHEQUES PAYABLE TO: Viki Zerdok
    MAIL TO: 168 Sommerhill, DDO, Quebec, H9A 1X1

    I agree to send in the 200$ deposit within 2 days of submission of this form.I agree

    LANGUAGE OF CONTRACT

    All Parties agree that the language of this contract is in English.

    Toutes les personnes acceptent que la langue de ce contract soit en anglais.

    In lieu of a signature, please check this box to agree all statements are true:I agree

    REFUND & NSF AGREEMENT

    The refund policy is as follows: The $200.00 deposit is non-refundable. All notice of cancellation must be made in writing no later than 3 weeks prior to June 27th, 2022. In such event, the camp fee will be reimbursed to you less the $200.00 deposit, which you by these presents authorize us to deduct. After this time, and prior to June 27, 2022, an additional 10% will be deducted from your reimbursement. After June 26th, 2022, no refund will be made. If the camp is unable to accept your child, all monies will be refunded. There will be a $25.00 charge for all NSF cheques regardless of the reason.

    I hereby certify that I have read and understand the refund & NSF agreement and agree to the provisions of this agreement.

    In lieu of a signature, please check this box to agree all statements are true:I agree

    Date(required):

    Returning campers do not need to fill out the below unless the info has changed.


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