Summer Camp Registration: CBS LOCATION This form takes registrations for our 2023 Summer Camp in CBS located at the Kiwanis Club, 925 Conception Bay Highway.1st Parent's Full Name(Required) First Last 1st Parent's Phone Number(Required)2nd Parent's Full Name First Last 2nd Parent's Phone NumberEmail(Required) Enter Email Confirm Email Correspondence will be sent to this email so please make sure the email you provide is one that is monitored regularly.How many children do you wish to register?(Required) 1 Child 2 ChildrenInformation for 1st ChildChild's Name(Required)Date of Birth(Required) Year Month Day MCP Number(Required)Does this child require any additional supports (ie. are there any medical, physical, or behavioural concerns our staff should be aware of?)(Required)Does this child have any allergies?(Required)Information for 2nd ChildChild's Name(Required)Date of Birth(Required) Year Month Day MCP Number(Required)Does this child require any additional supports (ie. are there any medical, physical, or behavioural concerns our staff should be aware of?)(Required)Does this child have any allergies?(Required)Additional InformationEmergency Contact Name(Required)This person must be someone OTHER than the parents listed aboveEmergency Contact's Phone Number:(Required)Additional people besides parents listed above who can pick up child and relationshipAny special requests for cohort grouping? If none, please respond N/A.Digital signature required: I hereby declare that the above information is correct. Please type your name in the section below to confirm.Camp Selection & PaymentSelect week(s)(Required) Week 1: June 26-30 [0 spaces available.] Week 2: July 3-7 [0 spaces available.] Week 3: July 10-14 [0 spaces available.] Week 4: July 17-21 [0 spaces available.] Week 5: July 24-28 [0 spaces available.] Week 6: July 31- Aug 4 [0 spaces available.] Week 7: August 7-11 [0 spaces available.] Week 8: August 14-18 [5 spaces available.] Week 9: August 21-25 [3 spaces available.] Week 10: August 28 - Sept 1 [13 spaces available.]Select AllNumber of Children being registered Quantity(Required)This number will be used to calculate your total registration price Price: $ 0.10 CAD Quantity Total Credit Card(Required)Cardholder Name Card Details Important Notice Regarding Tax Receipts Please keep the payment receipt you'll receive via email as your record for your taxes. No other receipt will be sent.PhoneThis field is for validation purposes and should be left unchanged.
