APM Summer Camp Registration Form
Helping Students Achieve Their Dreams (July and August)
Choose A Location
Black Walnut P.S
David Suzuki P.S
Legal First Name and Last Name:
Name of participants current school.
Please confirm Email Address. (Confirmation of Registration will be sent to Email Address)
Date of Birth
Please Choose One.
Please Specify: (If none please specify)
Special Dietary Accommodations:
If none, please specify:
Health Card #:
Does your child acquire extra staff assistance at school?
If Yes? You will be contacted in 24 hours on confirmation of student to staff support. All students benefit when their parents or care givers get involved in supporting their summer education. This is especially important if your child has a disability.
Pick Up and Drop Off Permission:
Please let us know the first name and last name of individuals given permission to pick up your child from camp or If your child has permission to walk home.
Emergency Contact Name:
Emergency Contact Telephone:
Emergency Contact Relation to the Camper
ex. mother, father, grandmother
Name of Person Registering Child:
Are you this child's parent or guardian?
Please Confirm Email Address
Please Select the Weeks you are interested in:
2 weeks minimum is required.
Week 1 (July 8th - 12th)
Week 2 (July 15th-19th)
Week 3 (July 22nd-26th)
Week 4 (July 29th-August 2nd)
Week 5 (August 5th-9th)
In order to complete registration payments must be completed before June 30th 2019
Regular $304.00/ week
Early Bird Special $150/week
Payments are due by June 30th 2019
In person (cash or certified cheque) On July 8th 2019
Please Request your Payment Plan
Every 2 Weeks
Please Include Comments/Request that you would like us to know?
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