Summer Camp 2016 - From June 27th to August 24th

9 weeks of adventure for kids from 5 to 12 years old

registration form

Child's first and last name: / Age:
Responsible parent: / Tel.1:
E-mail: / Tel.2:
Address: / Allergie:
IN CASE OF EMERGENCY, NAME AND PHONE NUMBER OF THE PERSON TO CONTACT:

Check the days, half-days and weeks chosen (AM: mornings – PM: evenings)

June

Monday / Tuesday / Wednesday / Thursday / Friday
27 / AM / 28 / AM / 29 / AM / 30 / AM / 1 / CANADA DAY
PM / PM / PM / PM

JULY

Monday / Tuesday / Wednesday / Thursday / Friday
4 / AM / 5 / AM / 6 / AM / 7 / AM / 8 / AM
PM / PM / PM / PM / PM
11 / AM / 12 / AM / 13 / AM / 14 / AM / 15 / AM
PM / PM / PM / PM / PM
18 / AM / 19 / AM / 20 / AM / 21 / AM / 22 / AM
PM / PM / PM / PM / PM
25 / AM / 26 / AM / 27 / AM / 28 / AM / 29 / AM
PM / PM / PM / PM / PM

AUGUST

Monday / Tuesday / Wednesday / Thursday / Friday
1 / AM / 2 / AM / 3 / AM / 4 / AM / 5 / AM
PM / PM / PM / PM / PM
8 / AM / 9 / AM / 10 / AM / 11 / AM / 12 / AM
PM / PM / PM / PM / PM
15 / AM / 16 / AM / 17 / AM / 18 / AM / 19 / AM
PM / PM / PM / PM / PM
22 / AM / 23 / AM / 24 / AM
PM / PM / PM

·  Day care (8am – 6pm): YES No

·  Allergies: NO YES Precise: ______

·  I authorize Re-Crea’s personnel to administer my child one or many of these medicines sold without prescription if necessary: Tylenol - Aspirin - Anti-inflammatory (Advil)- Antibiotic cream (Polysporin, etc.) - Antihistaminic (Benadryl, Claritin, Reactine, etc.) No yes precise ______

·  I authorize Re-Crea’s personnel to publish and use photos of my child on Re-Crea’s documents and/or website: YES NO

Date: / Signature: