Amberlea Summer Camp Registration
For 2018, Amberlea will host the following summer camps:

- Jul 16-Aug 23: Breakfast Club (Mon-Thu 9AM-12PM) Fee per day collected at drop-off
- Jul 23-27: Musical Theatre Camp (Mon-Fri 9AM-4PM) $125/child -- ages 7-15
- Aug 7-10: Musical Theatre Camp (Mon-Fri 9AM-4PM) $100/child -- ages 7-15

Please submit a separate form for each child and camp. Note that we cannot confirm your registration until we have received both your registration form AND your payment.

After you complete this form, make sure you go all the way to the end, and click the button labeled "SUBMIT"

Payment options:

(1) USE PAYPAL TO DONATE ONLINE
For your convenience, we have included a link to PayPal both here and on the confirmation page.
The link below will connect you to PayPal where you can make your donation. Our minimum is $40 per child or $100 per family. When you are finished with PayPal, the PayPal site will bring you back to this page. Remember to fill in the rest of this form and click "submit", we need both your information and your donation to complete your registration.
https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=EXKB2EAKSSYV8

(2) PAY IN PERSON AT AMBERLEA CHURCH
Worship services are Sundays 11:00 AM

For further information contact familyministries@amberleachurch.ca

The red asterisk(*) indicates required fields

Which Camp are you registering for? *
Child's Name *
First Name and Last Name
Your answer
Child's Gender *
Child's Age *
Child's age as of 9-July 2018
Child's Date-of-Birth *
Enter a valid date
MM
/
DD
/
YYYY
Child's last School Grade Completed *
As of 30-June 2016
Mother's Name *
First and Last name
Your answer
Mother's Phone (Daytime) *
Your answer
Father's Name *
First & Last Name
Your answer
Father's Phone (Daytime)
If not applicable, leave blank
Your answer
Street Address *
Your answer
City *
Your answer
Province
Your answer
Postal Code *
Your answer
Email Address *
Enter a valid email address in the form... "name@domain"
Your answer
Home Phone (Evening) *
Enter a phone number in the format 555-555-5555
Your answer
Home Church (if applicable)
Your answer
Alternative Emergency Contact Name *
If we cannot reach either parent (if not applicable enter "n/a")
Your answer
Emergency Contact Phone
if not applicable, leave blank
Your answer
Emergency Contact's Relationship to Child *
if not applicable enter "n/a"
Your answer
Others authorized to pickup child from Summer Day Camp
for example a caregiver or other relative
Your answer
Any medical conditions we need to know about *
Example: Exceptionalities, allergies. Please enter 'none' if the child has no medical conditions
Your answer
By submitting this form you consent to your child being photographed, video taped, or audio-taped as part of summer camp activities, and that Amberlea Church may use the photograph, video, or audio to inform the public of our family ministry programs, such as summer camp. *
Required
How have you made your donation? *
To make sure we match your donation to your registration, let us know how you paid...
Required
How did hear about us?
Anything else you want us to know
For example, if a grandparent (or other relative) whose name is not on this registration makes the donation, let us know how to match the donation to this registration.
Your answer
Would like information about Amberlea's "Exceptional Families Support Program"?
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service