Youth Stars Summer Camp Bonus Week 2022 Registration Form from August 15-19
Youth Stars Center: 57 Bd Westpark, Dollard-des-Ormeaux, QC H9A 2J8
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Email *
Campers Name *
Street name *
Number *
Apartment #
Borough *
If you answered other, please specify
Postal Code *
Age at the time of camp *
Date of Birth *
Name of child's school *
If you answered other, please specify
Is this your child's first time attending a day camp? *
Medicare Card Number *
Does the camper have any allergies? *
Please list any allergies &/or Dietary Restrictions
Does child carry an Epi-pen? *
Please list any medications being taken. Indicate dosage and frequency
Please list any Medical/Behavioural conditions
Does your child require one on one assistance / shadow? *
*Please note shadow's are limited
If your child requires one on one assistance / shadow, we will send you a separate questionnaire by email to fill out and send back to us. Once we receive the filled out questionnaire a member of our staff will contact you to schedule an in-person or virtual meeting with you and your child.
Parent / Guardian Information
**** Please note, persons listed as parent/guardian are authorized to pick up child
Parent/Guardian 1 Name *
Parent/Guardian 1 Phone Number #1 *
Parent/Guardian 1 Phone Number #2
Parent/Guardian 2 Name
Parent/Guardian 2 Phone Number #1
Parent/Guardian 2 Phone Number #2
Where did you hear about the camp? *
If you answered other, please specify
Campers T-Shirt size *
Camp weeks *
* Please note late fees of $1 per minute will be charged every minute starting after 6:05 pm
Please provide Name & Social Insurance # for Relevé 24 purposes: (not mandatory)
Will you require before and after camp daycare services(7:30 am - 9am & 4pm to 6pm) $8 / day. If you have selected yes for the daycare service, please choose the weeks *
Price for the Bonus Week is $200.00 tx included
Daycare fee is $8.00 per week
Payment Plan
Full amount due at the time of the registration
E transfers can be sent to:
Pay Cash : @57 Blvd west park ( email us to set time )
Credit Card : (email us for credit card link )

Includes Free Youth Stars membership and admin fees
Daycare $8 per day
Full payment required to be registered
Medical Emergencies
In the event of an accident, injury or illness involving the registrant, and immediate contact by Youth Stars with a designated contact cannot be made, I hereby authorize and grant permission to Youth Stars staff to secure proper medical treatment and authorize on the registrants behalf all procedures, including, without limitation, admission to an emergency unit, hospital and treatment therein, ordering of x-rays, tests or treatment, injections, anesthesia and/or surgery, as deemed necessary by the attending medical professional(s). I agree not to hold Youth Stars responsible for any costs or  injury arising out of an emergency situation
Name of Emergency Contact (emergency contact is authorized to pick up your child(ren) *
Phone Number *
Youth Stars will follow all health guidelines recommended by Public Health, the Quebec Government, ACQ and the CNESST to the best of our ability.By registering,Parent(s)/Guardians will accept that Youth Stars, following all safety protocols, cannot 100% guarantee non-exposure to COVID-19, and will not hold Youth Stars accountable should their child(ren) be exposed or contract the virus.All staff will receive extensive health and safety training in relation to Covid-19, and maintaining a safe environment.Parent(s)/Guardian will assume responsibility in ensuring they not send their child to camp, should they show any symptoms of Covid-19 as outlined by Santé Quebec.Upon registering and signing this form, parent(s) guardians accept any potential risk of their child contracting Covid-19, and understands that should an outbreak occur, Youth Stars may be forced to close camp for an undetermined time.

The parent/Guardian of the above named child hereby consent that he/she may participate in any and all of the Youth Stars Summer Camp activities. I hereby release and discharge the Youth Stars Foundation, its organizers and its directors and any and all volunteers from any and all future claims or demands for loss, damage or bodily injuries which may result directly or indirectly from participation in the said activity.
Youth Stars Foundation Summer Camp reserves the right to photograph and videotape my child’s classes and/or activities, artwork and/or performances and use them to future publicize our camps & programs.
Cancellation Fees
The YSF Camp reserves the right to cancel the Camp for which there is insufficient registration or due to unforeseen circumstances; in such a case, a full refund will be given. There will be a 50% cancellation fee per child, for any emergency cancellation.No refund will be given after the first day of camp.There will be a fee of $30.00 for any check returned by the bank.
By Initialling this document electronically, I have fully read and agreed to all the terms in this document
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Please enter your Initials *
Please add the date on which you have filled out and initialled this form *
A copy of your responses will be emailed to the address you provided.
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