« Fields marked with an asterisk (*) are mandatory.. »
STUDENT INFORMATION
First name
Last name
Date of birth
Age
Allergies/Health information
Medicare Card number
Expiration
Phone number 1
Phone name 1
Phone number 2
Phone name 2
Complete home address
Email
Please indicate the drop-off and pick-up time between 8am and 5pm (This will allow us to manage ratios for each group)
If you select the extended daycare service until 6pm, please indicated 6pm as the pick-up time.
Morning time
Evening time
Name of the person to contact in case of emergency
Phone
Relation
A) Please select the desired number of weeks of camp. Hold down Ctrl (or Cmd on Mac) to select multiple choices
Selected camp week(s)
Week 1 of July 1st: Wed-Thurs-Fri ($147)
Week 2 of July 6th ($245)
Week 3 of July 13th ($245)
Week 4 of July 20th ($245)
Week 5 of July 27th ($245)
Week 6 of August 3rd ($245)
Week 7 of August 10th ($245)
B) Please select the desired number of daycare service. Hold down Ctrl (or Cmd on Mac) to select multiple choices
Selected week(s) of daycare service
Week 1 of July 1st: Wed-Thurs-Fri - Before and after daycare until 6:00 PM $5/day ($15)
Week 2 of July 7th - until 6:00 PM $5/day ($25)
Week 3 of July 14th - until 6:00 PM $5/day ($25)
Week 4 of July 21st - until 6:00 PM $5/day ($25)
Week 5 of July 28th - until 6:00 PM $5/day ($25)
Week 6 of August 4th - until 6:00 PM $5/day ($25)
Week 7 of August 11th - until 6:00 PM $5/day ($25)
PAYMENT METHODS
*family discount applied to additional registration of the same household (to the total of the 2nd or the 3rd child)**The costs per week are based on registration of one (1) child, without taking into account the government
tax credit program (67%-78% tax credit according to household income).
Number
Exp
CVV
Date of the first payment
PICTURE AND VIDEO AUTHORIZATION
I authorize Centre Pédagogique La Renaissance Inc. and those acting on its behalf to :
PARENT/LEGAL GUARDIAN SIGNATURE
I have read and understood the information above.
Parent/Legal Guardian
Date
INFORMATION REGARDING THE TAX CREDIT
Name of the parent under whose name the statement will be issued
Mailing address
Social Insurance Number
SPECIFIC CONDITIONS:
Centre Pédagogique La Renaissance Inc. reserves the right to cancel the registration of any student who refuses to follow the established camp rules or demonstrates inappropriate behavior.
For the safety of our students, the parent or legal guardian must accompany the student to the camp waiting area or the designated entrance and return to pick them up at the scheduled time.
At the beginning and end of each day, the parent or legal guardian must sign the
"Arrivals/Departures" sheet. If this is not possible, the parent or legal guardian must sign the
"Release of Liability" form.
THE PARENT OR LEGAL GUARDIAN MUST ENSURE THAT THE STUDENT ARRIVES AT CAMP WITH THE REQUIRED ITEMS:
In the backpack:
Food: 2 snacks (morning and afternoon) and lunch
(Please provide "cold" meals only or place hot meals in a thermos).
As a preventive measure, please avoid products that may contain nuts/peanuts
due to potential allergies.
*BBQ lunch provided on Fridays*
Extra clothes in a plastic bag:
socks, underwear, t-shirt, pants, long-sleeved shirt for colder days, etc.
Cap/hat, sunscreen, swimsuit, towel,
sandals/water shoes, and a water bottle.
Dress Code:
Appropriate comfortable clothing and running shoes are mandatory
for indoor/outdoor physical activities (for the student's safety).
MEDICAL HEALTH DECLARATION:
The parents/legal guardians of the student guarantee that the student is physically fit
to participate in camp activities and consent to any employee, agent, or other
personnel affiliated with Centre Pédagogique La Renaissance Inc. seeking medical support,
treatment, or any other measure deemed necessary or recommended in the event of an accident,
injury, sudden illness, or any other health problem occurring while
the student is under the supervision of the camp administration or staff.
Furthermore, parents/legal guardians understand that camp staff will make
reasonable efforts to notify them in the event of an accident,
injury, sudden illness, or any other health issue, but they authorize camp staff to seek
adequate care even if neither parent nor legal guardian can be reached before the administration of care, treatment, or other measures. The parent/legal guardian signing this form releases Centre Pédagogique La Renaissance Inc. and its staff from all
liability for decisions or actions taken for the purpose of administering medical care. Additionally, they agree to pay all costs for medical care or treatments authorized by this declaration.
*DO NOT SEND YOUR CHILD TO DAY CAMP IF HE/SHE EXHIBITS SYMPTOMS THAT COULD BE
ASSOCIATED WITH COVID-19.
Any student with a fever over 37.2°C or requiring parental assistance will be sent home . In case of serious illness/injury/emergency, the day camp staff reserves the right to call an ambulance for your child.
LIABILITY DECLARATION: The parent/legal guardian agrees not to hold Centre Pédagogique
La Renaissance Inc., the staff, or the owners of the activity premises responsible for any damages, losses,
and/or expenses resulting from participation in camp activities and assumes all responsibility for
physical injuries, illnesses, or property damage occurring as a result of participation in camp activities. Furthermore, the parent/legal guardian understands that participation in the camp is voluntary, and the student understands the
risks associated with camp activities; the student agrees to comply with staff rules and policies.
• Should the number of registrations be insufficient at a specific location, we will provide an
alternative location or cancel the registration with a refund.
• Due to the short duration of the Day Camp program and limited capacity, student absences
will not be refunded without 2 weeks' prior notice.
LATE FEES : A fee of $5 will be added for each 15-minute increment that the responsible parent/guardian
is late to pick up their child. (Before 15 minutes late, the fee is $5. From the 16th
minute, an additional $10 will be charged, and so on.)
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