PA DAY CAMP PARTICIPANT REGISTRATION
All camp dates are Pay-What-You-Can (PWYC) with a suggested contribution of $15.00 per participant per date. Financial assistance is available.

TIME: 9:00 AM – 3:30 PM
LOCATION: Lakeshore Arts (2422 Lake Shore Blvd. W.)

CONTACT: Alessandra Cardarelli, School Programs Coordinator | alessandra@lakeshorearts.ca, schoolprograms@lakeshorearts.ca | 416.201.7093

Email address *
Please indicate what date(s) you like to enrol your child for? Please check all that apply. *
Required
REGISTRANT'S INFORMATION
Child's Name (First, Last) *
Your answer
Age *
Your answer
Date of Birth (DD/MM/YY) *
MM
/
DD
/
YYYY
School Attended *
Your answer
Home Address (Include City, Postal Code) *
Your answer
Parent(s)/Guardian(s) Name (First, Last) *
Your answer
Emergency Contact 1. Name (First, Last) *
Your answer
Emergency Contact 1. Phone Number *
Your answer
Relationship to Child *
Your answer
Emergency Contact 2 . Name (First, Last)
Your answer
Emergency Contact 2. Phone Number
Your answer
Relationship to Child
Your answer
Dietary / Medical / Behavioural Restrictions and or Concerns *
Please list any restrictions and/or concerns that are pertinent to your child, or if you would like to share any information with our staff that will aid and/or enhance your child's experience in our camp.
Your answer
Photography, Video and Media Consent *
I the parent(s)/guardian(s) submitting this application give consent for any photographs, videos or testimonials of the applicant to be used in all Lakeshore Arts marketing/promotional materials including the Lakeshore Arts website, social media pages and channels as well as third party media providers such as community newspapers, local/national newspapers and television channels.
How/where did you hear about our camp? *
Your answer
Payment
*
This is a Pay-What-You-Can program with a suggested contribution of $15.00 per participant, per day. If you would like to contribute to PA Day Camps at Lakeshore Arts, please provide your payment information here. If preferred please contact Lakeshore Arts for other payment options or to discuss financial assistance at 416.201.7093 or email schoolprograms@lakeshorearts.ca
Amount $
Your answer
For credit cards please select one option
Credit Card Number
Your answer
Expiry Date
Your answer
Cardholder Name (as shown on card)
Your answer
Cardholder's Full Address (St. #, St. Name, City, Postal Code)
Your answer
Liability Waiver *
While all reasonable measures and precautions will be taken to ensure the safety and good health of each camper/participant, Lakeshore Arts and staff are hereby released from any and all liability in the event of injury, accident, illness, or misfortune that may occur to the camper/participant and his or her property while in the care of Lakeshore Arts.
Required
I have read, understood the conditions of enrolment. I, the undersigned, the parent(s)/guardian(s) of the aforementioned, do hereby consent to his/her participation in the Lakeshore Arts PA Day Camp Program.
By entering your name and initials below you are effectively providing your signature, indicating that you understand, consent and agree to all the terms of enrolment and that all the information on this form is true and accurate, to the best of your knowledge.
Name and Initials *
Your answer
THANK YOU FOR REGISTERING!!! WE WILL SEE YOU AT CAMP!
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