Day camp registration form

REGISTRATION FORM – SUMMER 2016
PLEASE SELECT THE APPROPRIATE CAMP ABOVE.
RESPO NDENT
Last name : _______________________________ First name : _________________________________________
Status (father, mother, etc.) : ________________ S.S.N. (for RL-24) : __________________________________
Address : ______________________________________________________________________________________
City : _____________________________________ Province : __________________________________________
Country : _________________________________
Postal code : ______________________________________
Tel. home : (_______) _______________________ Tel. other : (_______) ________________________________
Email address : ________________________________________________________________________________
Where have you heard about our organisation? ___________________________________________________
1 st CHILD
Last name : _______________________________
First name : _______________________________________
Date of birth (DD/MM/YYYY): _______/_______/_______
Gender : M
F
Base of the age of your child on the first day at camp, select the appropriate age group :
Mini (3-4 years old)
Tout-petit (4-6 years old)
Petit (7-8 years old)
Moyen (9-10 years old)
Junior (11-12 years old)
Ado (13-15 years old)
Paired with : ___________________________________________________ (autorized if the same age group and gender)
2 nd CHILD
Last name : _______________________________
First name : _______________________________________
Date of birth (DD/MM/YYYY): _______/_______/_______
Gender : M
F
Base of the age of your child on the first day at camp, select the appropriate age group :
Mini (3-4 years old)
Tout-petit (4-6 years old)
Petit (7-8 years old)
Moyen (9-10 years old)
Junior (11-12 years old)
Ado (13-15 years old)
Paired with : ___________________________________________________ (autorized if the same age group and gender)
PAYM ENT AND REFUND PO LICY
At the time of registration, a deposit of $135 per child is required. It is also possible to pay the full amount. This amount is
payable by cash, check (payable to CAMPS ET CLUBS DE JOUR E.I.) or credit card*.
* Please provide the following informations.
VISA
MASTERCARD
Expiration (MM/YYYY): _______/_______
Credit card number : ______________________________ Cardholder : ______________________________________
Signature : ______________________________________________
I want to pay:
• the deposit of $135 per child at the time of registration.
•
the full amount at the time of registration.
Any additional amounts shall be paid by May 2 :
• in cash, directly to our headquarters;
• or post-dated check (May 2) the amount of the balance of the registration;
• or directly on the above credit card (otherwise, the balance will be charged automatically on the credit card).
The customer is responsible for the timely payment of all fees and must provide a valid payment method. A $25 fee will be
charged to the account for NSF checks and / or any requested change made after May 2.
A refund is only possible for medical reason with a doctor’s note. Upon such notice, served at least three weeks prior to arrival,
75% of the total costs will be awarded. Within three weeks of the start of the session, 50% of total costs will be reimbursed for
the unexpired portion of the stay. The refund may also take the form of a credit applicable to the following season.
CAMPS ET CLUBS DE JOUR E.I. reserves the right to cancel any program or option if the minimum number of registrations is not
reached in order to guaranty the quality consistent with our standards. The repayment of sums already paid will be granted.
Activities canceled due to bad weather are not refundable.
Signature : __________________________________________________________ Date : _____________________________________