School-age Summer Camp Registration Form
FOR CAMPERS BORN 2011-2016
Camp fee includes am snack, hot lunch and pm snack( Packed lunch on trip/excursion days)
Hours of operation 7:15-6:00  

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Email *
Payments:
 Payments will be processed via our Pre-Authorized Debit Form or cheque.

Invoices will be sent via QuickBooks 1 week prior to withdrawal.

Payments for chosen weeks in July will be withdrawn via Pre Authorized debit (EFT Canada) beginning July 4th or deposited(cheque). (Total amount for July will be debited/deposited)

Payments for chosen weeks in August will be withdrawn/deposited August 2nd 2022 (Total amount for August)

*Unfortunately, we are unable to accept cash or process credit card payments.
Camp Cancellations/Refunds:
If you need to cancel a week/s you must do so before June 1st 2022 via email or phone.

Requests for camp cancellations after June 1st must be made in writing and will be reviewed by the Director or Program Supervisor.

Camp starts July 4th any cancellation/refunds after camp has started will be subject to review on a case by case basis by Management.
Waitlist:
If the week you chose is sold out you'll be asked if you would like to be put on the waitlist for that week. The waitlist will be on a  first come, first serve basis. If a spot becomes available we will notify you.
Child's Name: Last, First *
Child's Address: Number, Street, City, Province, Postal Code: *
Date of Birth (mm/dd/yyyy) *
MM
/
DD
/
YYYY
Parent/ Guardian Name: **Person filling out the form** *
Parent/ Guardian Cell phone number: *
Parent/ Guardian Work Phone number: *
Parent/ Guardian Name:
Parent/ Guardian Cell phone number:
Parent/ Guardian email address:
Emergency Contact/s Name and relationship to child: *
Emergency Contact Cell phone number: *
Emergency Contact/s Work Phone Number: *
Health Card Number *
Child's Doctor's Name: *
Child's Doctor's phone number: *
Does your child have any allergies, special dietary restrictions or medical requirements? *
If you answered 'Yes':  1) What is the allergy/ dietary restriction or medical requirement?   2)What medical attention, if any, is required? (**Note: Anaphylactic allergies or asthma requires separate documentation to be completed**)
Authorization to release children (persons other than parents and emergency contacts who are allowed to pick up my child from the centre)  
Name/s of authorized release:
Cell phone number/s of authorized release:
Do you have subsidy? *
If you answered 'Yes', please record your subsidy number below.
LCCC T shirt: EVERY child must have an LCCC t shirt for trips $10.00 new /$5.00 used *
LCCC T-shirt  Size
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FIELD TRIP/ LOCAL EXCURSIONS/ACTIVITY: I consent for my child to participate in all field trips  (by chartered bus or public transportation,  if applicable), local excursions & activities *
PHOTOGRAPH CONSENT:  I consent for photographs to be taken of  my child during these experiences (photos to be used in the centre). *
CONSENT FOR EMERGENCY MEDICAL TREATMENT: Medical  treatment  may be given to my child at any time required due to accident, illness of other emergency. I hereby give my permission that if I am not immediately available, emergency ambulance transportation will be arranged by childcare staff.  The attending physician will administer emergency treatment as required.                                                                   *
ADMINISTRATION OF OVER-THE-COUNTER PRODUCTS: Please indicate below which products may be used on  your child.  Parents are responsible for providing own products, if applicable. With the exception of hand sanitizer, which will be provided by the centre.   *
Required
At LCCC we believe every child belongs, to ensure that your child's needs are met, Please indicate below if your child requires extra support whether diagnosed or undiagnosed so we can meet your child's individual needs within the parameters of care.
By registering, I consent to my above responses: Field Trip/Excursion/Activity, Photographs, Emergency Medical Treatment, Administration of over-the counter-products ***Please type initial or full name below to  accept as an e-signature alternative*** *
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A copy of your responses will be emailed to the address you provided.
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