Children's Camp Registration Form

Children's Camp
Registration Form

Child's Name: _________________________________________________________________
Age: _________	Date of Birth: ___________________
Ontario Health Card Number: _____________________________________________________
Critical Personal Information (medical conditions, allergies, special needs, etc.)
____________________________________________________________________________

Parent/Guaradian's Name: ______________________________________________________
Home # ____________________	Home # ___________________________
Work # ____________________	Work # ___________________________
Address: ____________________________________________________________________
Email: _______________________________________________________________________

Name of person(s) authorized to receive your child & relationship
Name: ____________________________	Relationship: _____________________________
Emergency contact person
Name: ____________________________	Phone #_________________________________

Registering for (please circle)	Week Camp	Day Camp	Full Day	Half Day
	Overnight Camp - Week		Overnight Camp - Per Night

Dates you wish your child to attend camp, please specify days and nights or whole weeks

______________________________________________________________________________

______________________________________________________________________________

Will you require (please circle)	Pre-care	After-care
Times care required: _______________________________________
How did you hear about West Winds Ranch? __________________________________________


Please make cheques payable to "West Winds Ranch"
Total Camp costs:		$ ________________
Total pre/after-care		$ ________________
	TOTAL	$ ________________
25% Registration Deposit		$ ________________
Signature of Parent/Guardian _____________________________________________________ Note: Insurance forms must also be completed and submitted.