Salam Shop MARCH BREAK Camp
Pay for camp here: https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=FU4Q3STEX9A72

...then fill out this form to ensure your child reserves a spot at the Salam Shop March Break Camp!
*Payment is non-refundable and non-transferrable*

PERSONAL INFORMATION
Student Name: *
Your answer
Birth Date (Day / Month / Year): *
Your answer
Home Address including Postal Code: *
Your answer
Home Telephone Number: *
Your answer
Parent's Names & Contact Numbers (Home / Work / Cell): *
Your answer
Who made the payment on Paypal for this camp? (Name + Email) *
Your answer
EMERGENCY CONTACT INFORMATION
Name of Emergency Contact: *
Your answer
Phone Number: *
Your answer
Relationship to Child: *
Your answer
Child Allergies: *
Your answer
Does your child carry an EPI pen? *
In the event of an emergency, may we release your child to your emergency contact? *
In the event of an emergency in which we cannot contact a parent or emergency contact, may release your child to a physician for care? *
CAMP INFORMATION
Have you made payment online of $100 + HST ($113.00)? *
Would you like the option of early drop off and late pick up, ie: instead of 10am - 2pm, 9am to 3pm. *
Do we have permission to use photos taken at camp of your child for marketing or advertising purposes? *
You will receive an email in 2-3 days with a list of items your child should bring to camp :) You will also be emailed a camp liability release form that must be signed and dated before your child can attend camp.
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