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(First & Last Name)
Child's Date of Birth
First & Last Name
How did you find us?
Toronto 4 Kids
Other social media
Local Emergency Contact
Name and phone number
Chronic Physical problem/Pertinent developmental info/ communicable diseases/ special accommodations deeded?
Allergies or intolerance to food or medications etc.:
Medications child takes:
PA day/ Drop & Shop
If you apply for one day camp
If you apply for one or more weekly camp
Week 1, December 27-December 28, 2018 (2 days)
Week 2, January 2-January 4, 2019 (3 days)
March Break Camp
March Break Camp March 11-March 15, 2019
If you apply for one or more weekly camp in 2019
Week 1, July 2-July 5 (4 days)
Week 2, July 8-July 12
Week 3, July 15-July 19
Week 4, July 22-July 26
Week 5, July 29-August 2
Week 6, August 6-August 9 (4 days)
Week 7, August 12-August 16
Week 8, August 19-August 23
Week 9, August 26-August 30
Weekly Camp Time
Half day 9 AM- 12 PM
Half day 1 PM- 4 PM
Full day 9 AM- 4 PM
Authorization & Waiver (please read & sign)
• I, for myself, heirs, executor, trustees, administrators, successors and assigns, waive any claims to which I may become entitled for injury or damage, and hereby release Explore Center and all their representatives, agents, instructors and directors and any other persons assisting in providing the programs, from any claims for damages or injury suffered by me as a result of my participation in the programs. I also hereby give my permission for the free use of my name, image and artwork in any broadcast, telecast, website, newsletter, newspaper, media or other form of publicity. I hereby certify that I am in good health and able to participate in the Explore Center programs. I hold the Explore Center harmless for any damages or injuries sustained on any activities. In case of any accident, Explore Center has my authorization to secure, at my expense, such medical attention as is deemed necessary for the individual named on this form. • I agree to a $1 a minute late pickup or early drop off fee. • All children must be signed in and out by a parent/guardian/designated person each day. • I have carefully read and understood terms of my enrollment in the Explore Center courses.
Registration & Payment
Please note: Registration is not secure until a payment has been received and is subject to availability. Summer Camp registration is non-refundable. Credits or refunds will not be issued for camp days not attended.
Please contact me to arrange the payment
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