∗Child's First Name:
∗Child's Last Name:
∗Age:
∗Gender:
∗Birthdate:
∗Address:
Suite/Apt #:
∗City:
∗Province:
∗Postal Code:
∗Name of School:
∗Current Grade:
PARENT/GUARDIAN 1 INFORMATION
∗First Name:
∗Last Name:
∗Relationship to Child:
Address (if different from Child's address):
Suite/Apt #:
City:
Province:
Postal Code:
∗Home Phone:
Cell Phone
Work Phone
∗Email Address
∗Authorized to pick-up Child:
PARENT/GUARDIAN #2 INFORMATION
First Name:
Last Name:
Relationship to Child:
Address:
Suite/Apt #:
City:
Province:
Postal Code:
Home Phone:
Cell Phone:
Work Phone:
Email Address:
Authorized to pick-up Child:
CAMP PROGRAMS
∗I would like to register my child for the following program:
Junior Camp, Grades 1 & 2
Lower Camp, Grades 3-5
Upper Camp, Musical Theatre, Grades 6-9
Upper Camp, Acting for film & t.v., Grades 6-9
Upper Camp, Pop Jazz Dance, Grades 6-9
Upper Camp, Visual Arts, Grades 6-9
Apply for volunteer C.I.T. position, Grades 10-12
BEFORE & AFTER CARE CAMP PROGRAMS
I would like to register my child for the following program
Please choose your daily bus stop (if applicable):
#1-Falstaff (30 Falstaff Avenue)
#2-Gracefield PS (177 Gracefield Ave.)
#3-George Anderson Public School (30 George Anderon Drive)
#4-George Harvey CI (1700 Keele St.)
#5-Dennis Ave. Community School (17 Dennis Ave.)
#6-Portage Trail Community School (100 Sidney Belsey Crescent)
#7-Roselands Junior PS (990 Jane St.)
#8-George Syme Community School (69 Pritchard Ave.)
ADDITIONAL CHILD INFO
∗Has your child taken any private or group lessons in music, dance, theatre or visual arts?
If YES, please explain:
∗Is your child experiencing any stressful or difficult life situations at home or school?
If YES, please explain
∗Are the child's parents divorced or separated?
Yes
No
Other
∗Who lives at home with your child? Please indicate relation to the child:
∗How did you hear about Horizon Arts Camp? If a specific person referred you, please put their full name here:
PAYMENT INFO
∗Please check your method of payment:
IN SUBMITTING THIS REGISTRATION, I AGREE TO THE FOLLOWING:
That Horizon Arts Camp reserves the right to photograph and/or videotape all arts programs and use the images for promotional purposes, unless notified by the parent/guardian in writing on or before the first day of the program.
To provide the camp with full health and authorized pick up information and payment for my child's application.
That my child is authorized to eat/drink all meals or snacks provided by the camp, unless otherwise notified by me.
That I understand that I will not receive a refund for any days my child is absent from the program.
That Horizon Arts Camp reserves the right to terminate the registration of any child if, in the camp's discretion, it is determined that such termination is to be in the best interest of the child or the program.
That my child is in good health and is able to participate in physically demanding activities related to the camp program.
That I give permission for my child's health information to be shared with the appropriate H.A.C. staff and outside medical personnel as necessary. If the parent or emergency contact can not be reached, permission is hereby given to H.A.C. staff to take whatever steps they deem necessary to ensure the safety and health of my child.
That the information in the child's registration is true and correct.
That I am the legal guardian/parent of the child applying and I am authorized to submit this application form for this child.
∗I have read, understand and accept the terms and conditions above:
If you received a PROMO CODE or GIFT CERTIFICATE, please enter it here (please note that only one will be accepted per application):
