Children’s Information				Medical Information
Child’s Name			Health Card Number
Gender: M or F	MaleFemale		Location
Grade in September			Date of Birth
Allergies / Puffers / Special Needs / Any Instructions (ADD, ADHD, PDD, AUTISM) / Comments:*
CONTACT INFORMATION
Home Address
Home Phone
Contact Email*
Contact	Name		Cell or Home		Email
Mother
Father
Emergency
Relationship
ENROLLMENT FEES INFORMATION
WEEK	START DATE	END DATE	$240/WK 9AM-4PM	PRE CARE 7AM-9AM ($20)	POST CARE 4PM-5:30PM ($20)	Cost
1	July 03	July 07	1	1	1
2	July 10	July 14	1	1	1
3	July 17	July 21	1	1	1
4	July 24	July 28	1	1	1
5	July 31	August 04	1	1	1
6	August 08	August 11	1	1	1
7	August 14	August 18	1	1	1
8	August 21	August 25	1	1	1
9	August 28	September 01	1	1	1
Total Number of Weeks
Administration Fee $50/Child:						$50.00
Subtotal
HST 13%
Total Fees:

TERMS OF ENROLLMENT: Due to COVID-19 We accept payments by e-transfer, or direct deposit
PHOTO RELEASE FORM: I hereby authorize Cool Summer Camp for the reproduction or display of my child’s (ren) artwork, photography, film, or audio recording for their current and future use in newsletter, website, and advertisement.
MEDICAL CONSENT STATEMENT: I authorize Cool Summer Camp to administer first aid to my child(ren) in an emergency as deemed appropriate and release their medical information to the attending physician/hospital.
CONSENT FORM: I authorize Cool Summer Camp to take my child(ren) on walking trips to the neighborhood, picnic, parks or other points of interests appropriate to their age group. I agree that the choice to participate in some indoor and outdoor activities brings with it the assumptions of those risks and results, which are part of these activities. I agree that Cool Summer Camp shall not be liable for any injury to my child(ren) or loss or damage to my child(ren)’s personal property arising from, or in any way resulting from my child(ren)’s participation in these activities.
REFUND POLICY: All deposits are Non-Refundable as their purpose is to confirm that your child will be attending the summer camp & that a spot will be reserved for them at Cool Summer camp for the above agreed weeks.
COOL SUMMMER CAMP reserves the right to dismiss a student if we feel the child is not fully independent (Potty Trained) and requires one-on-one supervision. In this case, any future payments owing will become null & void & the service agreement will be dismissed. CSC will also agree to refund the complete deposit as well as any remaining monthly tuition that may be remaining

Signature*