Summer Camp 2024 - Waitlist Form

How many campers are you registering? *

Primary Parent / Guardian Information

Full Name *

Address *

Email Address *

Confirm Email Address *

Phone Number *

Emergency Contact (other than parent/guardian above)

Full Name *

Phone Number *

Relationship *

Campers #1 Information

Full Name *

Date of Birth (Calendar goes to 2014, click on a random date in 2014 and the previous years will show) *

Grade Completed (June 2024) *

Health Card Number *

You have 14 chars left.

Medical Conditions/Allergies (please describe or place N/A): *

Attendance and Payment Options (select one box only)

6 weeks - July 2nd to August 8th - $750.00

3 weeks - July 2nd to July 18th - $375.00

3 weeks - July 22nd to August 8th - $375.00

Child Care (Morning 7AM - 9AM | Afternoons 3PM - 5PM)

Do you want Morning / Afternoon Childcare? *

Yes

Full Day - $10.00

Campers #2 Information

Full Name *

Date of Birth (Calendar goes to 2014, click on a random date in 2014 and the previous years will show) *

Grade Completed (June 2024) *

Health Card Number *

You have 14 chars left.

Medical Conditions/Allergies (please describe or place N/A): *

Attendance and Payment Options (select one box only)

6 weeks - July 2nd to August 8th - $750.00

3 weeks - July 2nd to July 18th - $375.00

3 weeks - July 22nd to August 8th - $375.00

Child Care (Morning 7AM - 9AM | Afternoons 3PM - 5PM)

Do you want Morning / Afternoon Childcare? *

Yes

Full Day - $10.00

Campers #3 Information

Full Name *

Date of Birth (Calendar goes to 2014, click on a random date in 2014 and the previous years will show) *

Grade Completed (June 2024) *

Health Card Number *

You have 14 chars left.

Medical Conditions/Allergies (please describe or place N/A): *

Attendance and Payment Options (select one box only)

6 weeks - July 2nd to August 8th - $750.00

3 weeks - July 2nd to July 18th - $375.00

3 weeks - July 22nd to August 8th - $375.00

Child Care (Morning 7AM - 9AM | Afternoons 3PM - 5PM)

Do you want Morning / Afternoon Childcare? *

Yes

Full Day - $10.00

Morning Only - $5.00/hr

Afternoon Only - $5.00/hr

Liability Waiver

I recognize that a risk willingly assume such risks for the above named person(s) for whom I am in law responsible and assume full responsibility during and after their participation in the program. The Pickering Islamic Centre (PIC) cannot be responsible for risk willingly assumed, and I therefore hereby release and forever discharge the PIC from all actions, damages, claims and demands whatsoever arising from participation in the program or any associated activities. I have read, understood and agree to the contents of this consent in its entirety.

Terms & Conditions

Camp hours are 9 am to 3 pm, Monday to Thursday
Campers 8 and under will not be dismissed from the lobby without adult supervision
Campers are required to bring their own snacks and lunch; except the days they are advised otherwise (i.e field trips)
Campers have to be in the building by 8:55AM everyday as the camp will start at 9:00AM
Campers are encouraged to wear sunscreen before playing outdoors
Campers are required to bring a water bottle
Campers are required to wear Islamically appropriate clothing (during camp and on the trips)
Field trip cost is not included in regular summer camp fees and varies depending on the destination (attendance optional).
Parents will be sent a one-time waiver form for all field trips
There will be no camp on Fridays, weekends and statuary holidays
Summer Camp will be closed on August 5th, 2024 (Civic holiday)
** Failure to describe any medical condition may results in the cancelation of the registration

We make every effort to accommodate each child; however, there may be situations where a child has needs which our staff are not equipped to support. We reserve the right to limit registration in such circumstances.

I accept above Liability Waiver and Terms & Conditions.

Signed Full Name