647-526-CAMP (2267) Welcome to Banbury Kids Camp 2017!!! To register a camper for Banbury Kids Camp, you must include the following: 1) The Camper Application Form (One per family) 2) Swim Form (One per child) 3) Emergency Form (One per family) 4) Camper Pick-up list (One per family) 5) Camper Information Release form (One per family) 6) Conditions of Registration form (One per family) 7) Two cheques ($400 deposit per child and remaining Balance dated April 1,2017) No refunds after May 1, 2017 Upon receipt of application, forms, and cheques, you will be notified by email of registration. (A parent handbook containing further information, including your camper s group name and number, will be emailed in May, 2017). Please MAIL all forms to our winter address at: Banbury Kids Camp c/o 33 Peterborough Ave Thornhill, On L3T 7C3
BANBURY KIDS CAMP 2017 CAMPER APPLICATION FORM www.banburykidscamp.com...(647)526-camp (2267) Registration Options Full Day Camp A Full Season- July 4 - Aug 25 $1800 B July Only- July 4 - July 28 $1000 C August Only- July 31 - Aug 25 $1000 D 2 weeks- July 31 - Aug 11 $ 535 E 2 weeks- Aug 14 - Aug 25 $ 580 (Please note: There is no camp on August 7 th. Camp finishes at 12:00 on Aug 25, 2017) CAMP HOURS: 9:00 am-3:00 pm (Must be 4 years old when camper begins camp & toilet trained) Camper Information (Please use this one form for all of your children) Camper s Name Gender (Circle one) Birth Date (mm/dd/yyyy) Session(s) Reg d 1 M / F A B C D E 2 M / F A B C D E 3 M / F A B C D E Parent s Name: Parent s Name: Home phone #: Home phone #: Cell Phone #: Cell phone #: Business Phone #: Business Phone #: Home Address: Email: (please print email clearly) GROUP MATE REQUEST: (for campers born in the same year, we will do our best to accommodate your request) Camper 1: I. II: Camper 2: I. II: Camper 3: I. II: Date: Parent s Signature: Banbury Kids Camp takes place at the Banbury Community Centre at 120 Banbury Rd
FOR FULL DAY CAMPERS ONLY BANBURY KIDS CAMP SWIM EVALUATION FORM To be sure your child is placed in the appropriate swim group, please return this form to Banbury Kids Camp as soon as possible. This will ensure that swim classes can be prearranged so that campers are put in groups as quickly and accurately as possible. This means more time swimming! Camper s Name: Camper s swim level: Session(s) Attending Banbury Kids Camp (please circle): A B C D E Please complete the following (please circle Yes or No for each question): Is the camper comfortable putting her/her face in the water? YES NO Can the camper swim independently on his/her front (face in the water)? YES NO Can the camper swim independently on his/her back? YES NO Can the camper swim independently the width of a pool? YES NO Can the camper swim independently the length of a pool? YES NO Is the camper comfortable swimming independently in deep water? YES NO Is there anything else you would like us to know about your child s swimming ability or experience?
EMERGENCY FORM 1) Child s name: Session Registered: (Please circle) A B C D E OHIP #: DOB: Allergies: My child requires an Epi Pen: YES NO 2) Child s name: Session Registered: (Please circle) A B C D E OHIP #: DOB: Allergies: My child requires an Epi Pen: YES NO 3) Child s name: Session Registered: (Please circle) A B C D E OHIP #: DOB: Allergies: My child requires an Epi Pen: YES NO Parent s Name: Parent s Name: Home phone #: Home phone #: Cell Phone #: Cell phone #: Business Phone #: Business Phone #: Doctor s name: Doctor s address: Doctor s phone number: Emergency Contact (if parents are not reachable) Name: Relationship: Phone Numbers: Home: Cell: Medical Consent In the event of a medical emergency, I hereby consent to the transportation of my child to the nearest medical facility. In addition, I consent to medical treatment as deemed necessary by the attending physician. I release Banbury Kids Camp from any liability involved in the transport and treatment of my child. Parent s Signature: Date:
PLEASE INCLUDE ANY ADDITIONAL INFORMATION IN A NOTE ATTACHED TO THIS FORM. (Photos are mandatory if your child has an allergy and/or uses an EPI PEN and/or there is any medical or behavioural information we should be aware of) PHOTO (CHILD #1) PHOTO (CHILD #2) PHOTO (CHILD #3)
BANBURY KIDS CAMP CAMPER PICK UP LIST 1. Camper s Name: Session Attending: A B C D E 2. Camper s Name: Session Attending: A B C D E 3. Camper s Name: Session Attending: A B C D E PEOPLE AUTHORIZED TO PICK UP YOUR CHILD (including parents): NAME RELATIONSHIP TO CAMPER Parent/guardian signature (Please notify the camp office of any changes to this Pick Up List )
Banbury Kids Camp Camper Information Release form 2017 Camper s Name: A) Do you consent to having photographs of your child/children appear on the Banbury Kids Camp website at as part of our Camp Life at a Glance? o I DO consent o I do not consent B) Do you consent to having photographs of your child/children appear on Twitter (Check us out @banburykidscamp on Twitter to make an informed decision). o I DO consent o I do not consent C) Do you consent to having your child/children be part of the group photo (July campers only) which is given to all the campers in the group? o I DO consent o I do not consent D) Do you consent to having your child s photograph be part of a slide show that is presented to the campers and staff at our July Show? o I DO consent o I do not consent Parent/Guardian Signature: Date: Camper #1 Camper #2 Camper #3 Thank you!!!
BANBURY KIDS CAMP- Conditions of registration Please read, sign, and include this page when mailing in application. TERMS OF PAYMENT 1) Please include two Cheques payable to Banbury Kids Camp: a) $400 non-refundable, non-transferable deposit for each camper b) Remaining balance post-dated April 1/2017 CONDITIONS OF REGISTRATION 1. Applications will only be processed with this application, the 2 cheques and all necessary forms. 2. No refunds will be given after May 1/2017. No refunds will be made for days missed due to illness, personal matters, or holidays. 3. Campers registered at Banbury Kids Camp have permission to participate in all camp activities and on any supervised trips or activities not on camp property. 4. We release and indemnify Banbury Kids Camp from any and all claims for damages arising as a result of any accident, injury, or otherwise sustained by the campers arising from participating in any camp activities where negligence is not the cause. 5. We understand the Director has the right to terminate the registration of any camper when it is decided by the Director to be in the best interest of the camp or the child. In such cases, only a proportionate refund will be made. 6. We agree to allow camp officials to act on my/our behalf in case of emergency. 7. Your Deposit Cheque is refundable in full if we are not able to confirm registration. Otherwise deposit cheques are not refundable. 8. Please do not drop off or mail forms to our summer address at the Banbury Community Centre. 9. The After Camp Tennis Program forms (found on the camp website) are to be sent directly to Lionel and are not handled by Banbury Kids Camp. 10. Registration and camper spaces are not transferable. 11. A $25 administration fee will be applied to any changes made after June 1 st. Form Checklist (to be used prior to mailing) 1) The Camper Application Form (One per family) 2) Emergency Form (One per family) 3) Camper Pick-up list (One per family) 4) Swim Form (One per child) 5) Camper Information Release form (One per family) 6) Conditions of Registration form (One per family) 7) Two cheques ($400 deposit per child and remaining balance) Parent signature: Date: