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August Day Camp Registration
Riverside United Church
Monday, August 10 - Friday, August 14, 2020
JK-Gr. 6
Monday-Friday 9:00am-4:00pm
Camper Information
How many children/youth will you be registering?
*
1
2
3
4
5
First Name
*
Last Name
*
Gender
*
Birth Date
*
+
Grade (in Sept)
*
JK
SK
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Select camp:
*
August VBS ($100.00)
Additional Camper Information
Additional Camper information (must be in same household)
First Name
Last Name
Gender
Birth Date
+
Grade
JK
SK
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Select camp:
August VBS ($100.00)
Additional Camper Information
(must be in same household)
First Name
Last Name
Gender
Birth Date
+
Grade
JK
SK
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Select camp:
August VBS ($100.00)
For families with three children attending the same week of camp (leadership camp not included), you are eligible to receive a discount for the third child. Click the information button below for details.
Family Discount Code:
🛈
Household / Adult Primary Contact
Relationship to Participant:
*
Mother
Father
Guardian
Other
Other
First Name
*
Last Name
*
Address 1
*
Address 2
City
*
Province
*
Postal Code
*
Phone
*
Alternate Phone
Email Address
*
Emergency Contact Name
*
Relationship to child
*
Emergency Contact Phone #
*
Camper Health Information
Health Information (including medications):
Allergies (please list and provide details):
Additional notes and information about your child:
Swimming Ability:
*
Health Card Number:
I give permission for photographs to be taken and used for promotional
purposes and social media postings (e.g. Facebook, Instagram).
*
Yes
No
Payment
Current Total:
$0.00
Calculate
Upon submission of your registration, online payment
options will be available via PayPal (no account needed).