2018 SPRING BREAK DAY CAMP Cost $15 PER DAY
Ages 5-12 March 26-29TH
CHILDS FIRST NAME *
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CHILDS LAST NAME
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CHILDS BIRTHDATE
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CHILDS ADDRESS *
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PHONE NUMBER *
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CAREGIVERS FULL NAME *
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DAYTIME PHONE NUMBER
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SECOND CARE GIVERS NAME
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DAYTIME PHONE NUMBER
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EMAIL ADDRESS
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MANITOBA HEALTH (SHORT NUMBER) *
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MANITOBA HEALTH (LONG NUMBER)
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BEHAVIOR/HEALTH CONCERNS
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GENDER *
Payment is requested on the first day of camp
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