Teen Registration Form
« Teens Summer Program |Below is the Teen Registration form . The camp will run Mondays to Thursdays from 1-4 pm. Please call 514 684 9584 or email sergio@taichimontreal.com for more information.
Teen Summer Camp – Registration Form
Name __________________________ Age ________________ Please circle Male Female
Address _________________________________________________________________
Mothers Name ________________ Fathers Name _______________________________
Phone Number during Day _______________ Phone number during____________________
Email Address __________________________________________________________
Medicare Number ___________________Expiry __________ Medical Conditions Yes No (if yes please record below)
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
______________________________________________________________________
____________________________________________________________________
Dr. Name and Phone number if medical conditions are listed _______________________
2. I authorize my child to participate in activities held in Pierrefonds-Roxboro parks and at the Roxboro pool; Yes [ ] No [ ]
3. These are the only people authorized to pick up my child:
1-_____________________ relation to child _________________tel :__________________
2-_____________________ relation to child _________________tel :__________________
OR [ ] I authorize my child to leave after the day camp program is over on their own
4. I understand and agree that an immediate written update must be given to the Center if the medical condition of my Child changes.
5.I authorize that the group’s animator/monitor/counsellor or any other responsible person of the Center to be aware of the information contained in this file and authorize the Centers personnel to provide aid to my child in case of emergency.
Parents hereby release the camp, its agents and employees from any and all claims for damages, loss or injury, infection or contamination to campers and campers belongings incurred during the camp or from the facilities being used, unless their has been gross negligence and willful misconduct of the camp, its agents or employees. Parents must keep their children at home while they are sick to prevent others from getting sick.
(www.taichimontreal.com ) I have read and understand all terms and conditions posted on the website
Date: _____________ Parents / Guardian Signature _____________________________