Rainbow Day Camp Registration

Camper's Full Name: 

Preferred Name:       

Parent/Guardian:             

Parent/Guardian:            

Relationship to Child:      

Relationship to Child:      

Home Phone:                   

Home Phone:                  

Work Phone:                   

Work Phone:                   

Cell Phone:                     

Cell Phone:                     

Email:                             

Email:                             

Please provide your email address to receive newsletters, updates etc. Please read our Privacy Statement for more information.

Home Address:  Apt #:   City:  Postal Code:

Alternate Emergency Contact:   Relationship to child: 

Day time phone:

Are you applying for a subsidy? Yes , No if yes, from which agency?

About your camper

Gender:  F  M    Birthday:  D  M  Y

School:    Grade Entering: 

Health Card Number: 

T-Shirt Size: Kids   XS    S    M   L    XL - Adult   S    M   L

If your child has a same-age friend or sibling that would like to be in the same group, please indicate that child's name and grade (we will make every attempt to accommodate your request)

Tell us a bit about your child (i.e., favourite activities, dislikes, useful tips that work well with your child, shy/anxious about going to camp, anything else we should know)

Medical Information

Does your child have allergies?  none
                                                   mild (no medication needed)                   To: 
                                                   moderate (carries a puffer or Benadryl)  To: 
                                                   serious (but not life threatening)            To: 
                                                    anaphylactic (has an Epipen)

Does your child have special needs? 

Does your child need support while at camp?  No  Yes

Safe Arrival Program

How will your child get to camp? (ie: Car, Bike, Bus, Other)  

Who can drop off or pick up your child from camp, besides theparent or guardians listed above?

   1.    2. 

   3.    4. 

(Please note: These are the only people that Rainbow Day Camp staff will release your child to. If there is a change, please call camp as soon as possible. Identification will be required.)

Registration

2011 Camp fees are $165 per week, with the exception of session 5 which is $132 due to the shortened week. Your spot is not confirmed until payment has been received. We accept cash, money orders, personal cheques or e-mail money transfers prior to June 15, 2011. Personal cheques will not be accepted for payment after June 15th. Extended care is available from 8am to 5pm for $15 per week, except for week 5 which is $12 due to the shortened week.

Parent / Guardian Waiver

Being the parent/guardian of  who is enrolled with Rainbow Programmes for Children, I have read and agree to all of the Enrolment & Participation Policies. I further agree to release and indemnify Rainbow Programmes for Children and the University of Guelph from any claims for damages arising as a result of any accident, injury, or otherwise sustained by the herein named child arising from participation in any camp activities.

By Checking this box you are signing the document:    Date: