CHEER Registration Form

Child’s Name Birth Date (Y/M/D) Ontario Health Card #

______/_____/______

Address: _______

Phone:______Emergency phone: ______

Email: ______

Family Doctor: ______Doctor’s Phone: ______

Health or special concerns? No Yes

Please provide details of any necessary treatment as well as the name and dosage of any necessary medication required. CHEER cannot be

responsible for a student’s medication. Any medication must be self-administered. (Please use back of page if necessary)

______

At each CHEER day we desire there to be a warm, friendly atmosphere that is characterized by “love your neighbour as yourself”. We

require all participants to maintain an attitude of respect towards the instructors, their peers and the facilities. Please have your child

sign in the space provided once this has been explained to them.

Child’s Signature ______

The spring 2002 CHEER term will be each Thursday from March 21, 2002 to June 6, 2002. The program will be from 12:30 – 3:15 each week and students will be instructed in French (Latin for the teens), Art and Science. This program is available to students ages 5 and up for $8 per day. ($8 x 12weeks=$96)

CHEER is a program that is organized by volunteers. With emphasis on student safety, every parent is expected to assist 2 Thursdays of this 12 week program as a “Parent Supervisor”. A calendar will be posted on March 21 to enable parents to select dates. (Parents may have opportunity to pay a fee and have others act as “Parent Supervisor” for them.)

We are in the process of planning spring CHEER morning workshops (e.g. drama, ballet, chocolate making, creative writing, cooking) Are you interested in being contacted with further information? YES NO

Workshop selection may be written on the back of this form. Workshop payment must accompany this form. In case of low enrolment, workshops may be cancelled, in which case a full refund will be made.

CHEER wishes to convey total respect for each family’s wishes in regard to publication of photos for promotional purposes. Please check all preferred boxes.

Use pictures on web site (no names will be given)

Use pictures for media purposes (newspapers, newsletters, brochures, TV)

I prefer NO pictures be used

I, the undersigned will not hold CHEER or Trinity Bible Church responsible for any medical or personal injury due to negligence or any

other loss or damage and therefore waive any claim against CHEER. In the event of injury or illness, I authorize CHEER personnel or

designate to seek and obtain such emergency or medical services as may be deemed necessary at the time.

______

Parent’s Name Parent’s Signature Date

Registration forms must be completed in full, accompanied by a $20 deposit per student and post dated cheques for April 1 and May 1, 2002 for the balance OR payment in full. Registration are to be mailed to Grace Mussell 3401 River Road, Manotick, Ontario K4M 1B4.

Early registration is encouraged due to limited space. Cheques will be returned to any families unable to be accepted into the program.

It is very important the entire registration form is understood and completed in full before submitting to CHEER.