Highlands Summer Camp Registration 2017
Join us for some fun this summer at one of our musical theatre camps or one of our day camps: Breathe it In and Digging for Treasure! Please note there is a separate application for those interested in our "Adventures in Leadership" program that must be completed *in addition* to this camp registration form.

If you are registering for our Squamish United Church/St. John the Divine summer camp, please find it as the last camp listed under the registration category.

General Information
Name of Parent(s) or Guardian
First, Last
Your answer
Address
PO Box #, Apartment #, house number or street
Your answer
City
Your answer
Province
Your answer
Postal Code
Your answer
Email Address
All correspondence is conducted by email. Please ensure this is an address you check regularily.
Your answer
Phone Number
Your answer
Alternative Phone Number
Please include a work or cell number where we can reach you during the camp day.
Your answer
Emergency Contact Person
Your answer
Relationship to child
Your answer
Contact phone number during camp
Your answer
How did you hear about our camps?
Check all that apply
Required
Children's Information
Please use an additional form if registering more than 2 children
Child's Name
preferred first name, last name
Your answer
Gender
what gender identity/ies best fits your child?
Your answer
Birthdate
DD/MM/YY
Your answer
Grade as of September 2017
Your answer
BC Care Card Number
Your answer
Allergies, dietary restrictions, or special needs
Please provide as much detail as necessary to ensure your child's well being at camp
Your answer
T-Shirt Size
Mark only one
For which camp(s) would you like to register?
Please check all that apply **Please note Musical Theatre Camp (gr. 1-4) is now FULL. Email cyaya@highlandsunited.org to be added to the waitlist.
Required
Child #2 Name
preferred first name, last name
Your answer
Gender
what gender identity/ies best fits your child?
Your answer
Birthdate
DD/MM/YY
Your answer
BC Care Card Number
Your answer
Grade as of September 2017
Your answer
Allergies, dietary restrictions, or special needs
Please provide as much detail as necessary to ensure your child's well being at camp
Your answer
T-Shirt Size
Mark only one
For which camp(s) would you like to register?
Please check all that apply **Please note Musical Theatre Camp (gr. 1-4) is now FULL. Email cyaya@highlandsunited.org to be added to the waitlist.
Permission and Release Information
Release Form
By clicking 'I agree' I acknowledge that the child/children on this form is participating in these summer camps voluntarily and that Highlands United Church will not assume responsibility for injury, loss, or damage sustained by participants during the course of this program. I authorize camp staff to seek emergency medical treatment for my child should the need arise.
Photo Permission
By clicking 'I agree`, I give permission for my child`s photograph to be used on Highlands United Church publications including web site, program promotional materials or brochures. I understand that my child`s name will not be used unless I have given my written permission.
Video Permission (Musical Theatre Camp/Boot Camp Only)
By clicking 'I agree', I give my permission for my child to be seen in the video recording of the final musical theatre production. I understand that this video will be available for purchase by families of participants.
Payment Information
If registering a child in 2 or more full day camps or registering more than 1 child in full day camps, please deduct $25.00 from the second (and additional) child's registration fee or camps. Prices listed include any applicable early discounts.

After clicking 'submit' you will be directed to the pay pal site for completing payment by credit card. Please call 604-980-6071ext 24to make your payment if you are not directed to pay pal.

Please note that ALL early bird deductions (for registrants prior to May 15th) are taken into account in the prices above.

A cancellation fee of $25 will be charged up to the week before the camp, after which the cancellation fee will be 50% of the total camp cost.

Total Cost
Please let us know the total cost of your summer programming as per prices listed above. Note the early bird registration fees valid until May 15th! If you are in need of financial assistance please contact cyaya@highlandsunited.org
Your answer
For Office Use Only
Payment Received
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms