Summer Camp Registration Form
Student Personal Information | |||
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Student's Name
_______________________ |
Date of Birth
_______________________ |
Sex
____ |
Language
_________________ |
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Address
_________________________________________________________________________ | |||
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Telephone No.
_______________________ |
Fax No.
_______________________ |
Grade in Chinese School
_______________________ | |
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Parent's/Guardian's Name
_______________________ |
Relation
_______________________ |
Daytime Contact No.
_______________________ | |
Student Medical Information | |||
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Family Doctor
_______________________ |
Doctor's Tel. No.
_______________________ |
Health Card No.
_______________________ | |
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Allergies/Special Care
_________________________________________________________________________ | |||
Emergency Contact | |||
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Name
_______________________ |
Relation
_______________________ |
Daytime Contact No.
_______________________ | |
Parent Authorization & Consent
I hereby give permission for my child to participate in the Summer Camp held by Chinese Cultural Centre of Greater Toronto, and to receive any emergency treatment if necessary. I hereby release and forever discharge the CCC from all actions, damages, claims and demands whatsoever arising by reason of participation in the activity. I have read, understood and agreed to the contents of this Consent in its entirety.|
Signature
_______________________ |
Parent's/Guardian's Signature
_______________________ |
Date
_______________________ | |
| Date | Tuition | Child Care | Amount | |||
| Full | Half | AM | PM | |||
| Week 1 | 07/03–07/06 | |||||
| Week 2 | 07/09–07/13 | |||||
| Week 3 | 07/16–07/20 | |||||
| Week 4 | 07/23–07/27 | |||||
| Week 5 | 07/30–08/03 | |||||
| Week 6 | 08/06–08/10 | |||||
| Week 7 | 08/13–08/17 | |||||
| Week 8 | 08/20–08/24 | |||||
| Week 9 | 08/27–08/31 | |||||
| Total | ||||||
For Office Use Only
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