bd holiday glee clubs registration form

8/14/2019 BD Holiday Glee Clubs Registration Form

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Camp Registration FormAddress Information:Street Address:

Unit #:_________________________City:________________________________ Postal

Code:___________________________

Mother Information:First Name:________________ _ Last Name_________________ __

Daytime Phone #:_(____)____________ Evening Phone #:(____)_____________Email Address:

Father Information:First Name:_______ _ Last Name:__________________________

Daytime Phone #:(_____) ___________ Evening Phone #: ( ) _____________Email Address:

An email address is required. Your camp confirmation, login information and other importantcamp correspondence will be sent to the email address provided.

Child Resides with (please check one): Mother Father Other

First Name:_________________ Last Name:_______________

Relationship:Tel #: ( ) Email:

Address:

CHILD # 1Please use the Notes section below to provide us with medical information (allergies,disabilities, etc.) about your child (if applicable)

First Name: Last Name:

Gender: Male Female Date of Birth : / / /Month / Day / Year

School: Grade:

Health Card #:

Allergies: NO, If Yes, please specify:

Primary Doctor: Tel #: ( )

Additional Comments:


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CHILD # 2Please use the Notes section below to provide us with medical information (allergies,

disabilities, etc.) about your child (if applicable)

First Name: Last Name:

Gender: Male Female Date of Birth : / / /

Month / Day / Year

School: Grade:

Health Card #:

Allergies: NO, If Yes, please specify:

Primary Doctor: Tel #: ( )

Additional Comments:

Emergency Contact (other than parent)

Name:____________________________________________________________

Address:___________________________________________________________

Relationship to child:_________________________________________________

Daytime Phone #:(______)______________Email: _________________________

Week Child 1 is Attending Camp (please check):

Week #112/21 12/24, 2009

Week #212/28 12/31/2009

Camp Fees: $150/week Plus $5 Registration

$155 / week

Camp Fees: $150/week Plus $5Registration (if attended week one no

need for registration fee)

SUB-TOTAL: $150 /week plus $5(if applicable):

Discount (if applicable): Discount:(if applicable):


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SUB-TOTAL: SUB-TOTAL:

Week Child 2 is Attending Camp (please check):

Week #112/21 12/24, 2009

Week #212/28 12/31/2009

Camp Fees: $150/week Plus $5 Registration

$155 / week

Camp Fees: $150/week Plus $5Registration (if attended week one noneed for registration fee)

SUB-TOTAL: $150 /week plus $5(if applicable):

Discount (if applicable): Discount:(if applicable):

SUB-TOTAL: SUB-TOTAL:

**Dont Forget: Deduct 10% of above totals for family discount ifmore than one child OR $10 off if registering by November 30, 2009***You can only apply one or the other not both discounts offeredabove.

Registration Confirmation will be sent via email, subject to availability at time

of processing. Please call 1-416-722-9343 if you require assistance.

A $25 fee applies to any declined credit card or NSF Cheque received.

Sub Total Child 1: $

Sub Total Child 2: $

Discounts: $

Total $

G.S.T. (5% ofTotal Line)

$

Grand Total $


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Method of Payment (circle): VISA / MASTERCARD / CERTIFIED CHEQUEMake cheques payable to Bounce Delight.

Credit Card#__________________________________________________

Expiry Date:__________________

Full Name on Card (Please Print):______________________________

Authorized Signature:

REGISTRATIONS WITHOUT A SIGNED WAIVER WILL NOT BEPROCESSED

I hereby release, waive and forever discharge Bounce Delight GleeClubs, Bounce Delight, Penzzi Holdings Inc., Jubilee Victory Church andtheir employees of and from all claims arising from participation in anyactivity unless such injury, loss or damage is caused by the solenegligence of Bounce Delight Glee Clubs, or its employees while actingwithin the scope of their duties. I, the Parent/Guardian, agree that anyphotographs or digital video taken by Bounce Delight staff or campersmay be used in any future advertisement or promotion of BounceDelight.

Parent/Guardian Printed DATE

Parent / Guardian Signature

Contact Us:Tel #: 1-416-722-9343 Email: [email protected]

Fax #: 1-416-981-8968Website: www.bdgleeclubs.com

** Please attach all camp forms and return to us with yourregistration**
http://www.bdgleeclubs.com/http://www.bdgleeclubs.com/

bd holiday glee clubs registration form

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