Hillcrest Private School

Summer Camp Registration

 

Please fill out the application below for admission to Hillcrest Private School’s Summer Camp 2012!

Once the form is completed and “submitted” a Hillcrest administrator will reply to confirm your registration.

If you do not receive an e-mail confirmation and or phone call, within 7 days, please contact the school at 519-941-5591.

Please note that a parent or guardian will be required to sign a copy of your registration form on the first day of camp before a student may attend.

*Once the form is filled out, please click the Submit button to complete the registration form.

Please check the week(s) you would like to sign up for. Please indicate if you need half-days or parts of a week, when you are contacted to confirm your information and we will let you know the cost. We require a deposit of $50.00/per child/week to complete the registration. This deposit will be removed from the total of your child’s fees for that week.

Thank you,

Hillcrest Private School

Child's Last Name

Child's First Name

Street Address

Postal Code

Home Phone Number

Family Email Address

City

Current Grade

Will you be requiring Before and After Care?

If Before and After is required what days and times (also if there is a different person picking up a password and ID are needed).

Mother's Full Name

Mother's City

Mother's Street Address

Date of Birth

Health Card Number

Mother's Postal Code

Mother's Home Phone Number

Mother's Work Phone Number

Mother's Cellular Number

Father's Full Name

Father's Street Address (if different from above)

Father's City (if different from above)

Father's Postal Code (if different from above)

Father's Home Phone Number (if different from above)

Father's Work Phone Number

Father's Cellular Number

Child's Doctor's Name

Child's Doctor's Phone

Medical Information

Please enter any important medical information.

Emergency Contact #

Emergency Contact Number

PLEASE CHECK THE BOX(ES) THAT YOU ARE SIGNING YOUR CHILD UP FOR.

• Week 1 Be a Viking Week - July 3rd to 6th
• Week 2 Cooking Week - July 9th to 13th
• Week 3 Reptiles Week - July 16th to 20th
• Week 4 Sports Week - July 23rd to 27th
• Week 5 Rocketry Week - July 30th to Aug. 3rd
• Week 6 Outdoor Explorers Week - Aug. 7th to 10th
• Week 7 Dinosaurs Week - Aug. 13th to 19th
• Week 8 Survivor Week - Aug. 20th to 24th

Permission Any expenses incurred for any kind of medical attention, will be borne by the child's family. Hillcrest will not be responsible for anything that may happen as a result of false information given at the time of enrollment. I hereby grant permission for my child to use all of the play equipment and participate in all the activities of the Summer Day Camp. I hereby grant permission for my child to leave the Hillcrest premises under the supervision of a staff member for neighbourhood walks or for field trips in an authorized vehicle. I hereby grant permission for my child to be included in all games and activities with all the other children and will not hold the Hillcrest responsible for any injuries that may occur from these activities. I hereby grant permission for the person in charge that day to take whatever steps may be necessary to obtain emergency medical care if warranted. If we cannot contact you or your child's physician we will do any or all of the following: 1) Call another physician or paramedics. 2) Call an ambulance. 3) Have the child taken to an emergency hospital in the company of a staff member. PLEASE READ CAREFULLY **With the enrolling of my child at Hillcrest Private School Summer Camp, I will pay a $50 deposit for each week my child is enrolled and fulfill my financial obligation so my child is allowed to participate in the Hillcrest Summer Day Camp. There is a 2% interest charge on all outstanding account balances and a $35 service charge for any returned cheques. Families who have outstanding balances will be asked to leave the Summer Day Camp and will not return until their accounts are in good st

I agree to the above statements

Sign this copy at the school SIGNED: __________________________DATE:_______________________