2015 Registration Form

2015 REGISTRATION FORM (514) 836-8999
Camper’s Name: __________________________________ DOB (M/D/Y): _____/_____/_____
Gender: d Male d Female
School: ________________________________ Grade: _______
Parent Information:
Mother’s Name: _____________________________________________________________
Address: __________________________________________________________________
City: _________________________________ Prov/State: _____________________________
Postal/Zip:____________________________ _Home: ________________________________
Cell: ________________________________ Business: ______________________________
Other: ____________________________________________________________________
Email: ____________________________________________________________________
Father’s Name: ______________________________________________________________
Address: __________________________________________________________________
City: _________________________________ Prov/State: _____________________________
Postal/Zip:____________________________ _ Home: ________________________________
Cell: ________________________________ Business: ______________________________
Other: ____________________________________________________________________
Email: ____________________________________________________________________
Marital status of parents (please circle):
Married
Separated
Divorced
Widowed
(Canadians) Social Insurance # for child-care tax receipt: ____-____-____ of father/mother (circle one)
Names/ages of camper’s siblings and ages, if any: ______________________________________
________________________________________________________________________
Emergency contact: ___________________________________________________________
Relation to camper: __________________________ Home: ____________________________
Business: _________________________________ Cell: ______________________________
Bunk mate preferences: 1. ___________________________ 2. _________________________
Tell us more about your child
What does your child like doing most? (games, sports, activities, etc.)__________________________
________________________________________________________________________
________________________________________________________________________
Is your child excited about coming to camp? d Yes d No
Is he/she comfortable being away from home/parents? d Yes d No
Has your child attended camp before? d Yes d No
Was it a good experience?_______________________________________________________
Please tell us if your child has any fears that we should know about (i.e. the dark, thunder and lightning,
the lake, bugs): ______________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Swimming
How well does your child swim? d Beginner d Intermediate d Advanced
Last swim level passed? ________________________________________________________
Has your child ever swam in a lake? ________________________________________________
Activities
Are there any particular activities that you would like your child to be encouraged to try?_____________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Daily Life
How would you describe your child’s eating habits?
d Picky
d Average
d Eats everything
Does your child d Sleep walk d Have night terrors d Wet the bed d Have trouble falling asleep?
Does your child wear glasses? d Yes d No Should he/she wear them all of the time? d Yes d No
Does your child make friends easily? d Yes d No _____________________________________
Other
Is there any other information that you would like to share with us about your child?________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Fees and Payment Info
d Full Session: June 25-August 10___________________________________________ $6,600
d Full Session (grades 1-3): June 25-August 10__________________________________ $3,250
d First Session: June 25-July 26_____________________________________________ $4,700
d First Session (grades 1-3): June 25-July 26___________________________________ $2,250
d Second Session: July 13-August 10_________________________________________ $3,700
d Second Session (grades 1-3): July 13-August 10________________________________ $1,750
d Starter: (open to campers completing grades1-3) June 25-July 12 ($500/Week)___________ $1,000
d CIT (completed grade 10): June 25-August 10__________________________________ $7,200
d LIT (completed grade 11): June 25-August 10__________________________________ $2,100
d CHX (per week registration)______________________________________________ $1,100
Visiting day Sunday July 26. Sibling discounts: 2nd child save $100, 3rd child save $200.
Our prices DO NOT include GST/PST taxes. Our prices DO include canteen (tuck), laundry, local field trips,
transport from Montreal to camp on June 25 and transport from camp to Montreal on August 10.
Payment Method: d Cheque
d Visa
d MasterCard
d Wire Transfer
Please make cheques payable to Camp Wingate. Forms can be scanned and emailed to
[email protected] or mailed to:
Camp Wingate, 6600 Decarie, Suite 110, Montreal, Quebec H3X 2K4
Card Number: __________-__________-__________-__________ Exp. (mm/yy) _____ /____
Name on card: ________________________________________ Sec. Code: ______________
There is a 2% charge if paying by credit card
All registration forms must be accompanied by a $1,000 deposit by March 1, 2015 except for STARTER
CAMP forms, which must be accompanied by a $500 deposit.
Balance of payment is due May 1, 2015
Signature of parent or guardian: ______________________________ Date: _______________
Terms and Conditions of Registration and Cancellation Policy:
As the parent (or guardian) of the camper who is the subject of this registration form. I hereby agree to the following terms and conditions,
and I warrant that all of the information I have provided on this registration form is both truthful and accurate:
1) Reservations will be confirmed by the camp once this completed and signed registration form is returned to the camp office along with
post-dated cheques (or credit info) for the full payment (see attached fee schedule).
2) a. For cancellations made before April 1, 2015, the camp will refund the fees paid less $375 per camper.
b. For cancellations made between April 2 and June 1, 2015, the camp will refund the fees paid less $775 per camper. For cancellations
after June 1, 2015, there are no refunds.
c. In cases where a camper does not complete his/her reserved session, the camp will issue a refund of 50% of the portion of unused
time greater than one week (for example, if a camper misses 4 weeks of his/her session, the refund will be 50% of 3 weeks). However
no refunds are paid for campers sent home early due to non-compliance with camp policies which forbid drugs, alcohol, smoking,
vandalism, theft and abusive behaviour.
3) Should a camper registered for a full-season change to a shorter session, parents will be billed at the new sessions rate in effect at
the time of the change in reservation.
4) I allow the camper to participate in all activities organized by the camp, both on and off camp property. I also allow the camper to
participate and appear (via photographic images, video and/or audio recordings), without any compensation, in all materials produced
ad displayed or distributed to the public via any form of media.
5) Although the camp makes every effort to return lost or misplaced articles, I agree not to hold the camp responsible for lost, damaged
or stolen property of the camper. It is STRONGLY recommended that campers not bring any valuable belongings to camp. I agree to
comply with the camp’s electronics policy which prohibits campers from having any handheld gaming consoles, iPads/tablets/laptops,
iPod Touches, cell phones or other similar network powered communication devices at camp. The camp will confiscate any that are
found.
6) If the camper who is the subject of this registration form is a non-resident of Canada and/or is not the holder of a valid health-care
card issued by a Canadian province (which must be valid through the completion of the camper’s session), I warrant that I shall acquire
adequate medical insurance for the camper with coverage through the camper’s entire stay in Canada and at the camp and agree to
re-imburse the camp or camp medical staff for any medical costs incurred for my child.
7) I authorize the camp administration and medical staff to act for me according to their best judgement in any emergency involving the
camper requiring medical treatment. (Every effort will be made to contact parents immediately). I give the camp permission to contact
the camper’s physician if necessary. I agree that the resolution of any and all disputes which may arise between myself and the camp
or the camp medical staff relating to the camper shall be governed by and construed in accordance with the laws of the Province of
Quebec. I agree that any complaint, demand, claim or cause of action against either the camp or camp medical staff shall be commenced only in the Province of Quebec, and I hereby irrevocably submit to the exclusive jurisdiction of the Courts of Quebec.
8) I agree that the camp reserves the right to dismiss or not re-accept the camper for behavior detrimental to the group or camp environment. In order to help assure the safety and security of the camp population and maintain a drug and alcohol-free environment, I
expressly give the camp administration the right to conduct a search of the camper’s belongings if deemed appropriate.
9) I have read and agree to all the above Terms and Conditions of Registration and Cancellation Policy. I agree that this document be
drafted in English. Je confirme ma demande que ce document soit rédige en anglais.