Summer Program RegistrationStep 1 of 714%Camper InformationChild's Name(Required) First Last Child's Date of Birth(Required) MM slash DD slash YYYY Grade in September(Required)Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th GradeSchool in September(Required)Gender(Required) Boy GirlSchool BoardFamily Contact InformationWho has legal custody of this camper:(Required) Mother Father Both Parents OtherName of Parent/Guardian 1(Required) First Last Is available for contact while child is at camp:(Required) Yes NoRelationship to the camper:(Required)Address(Required) Address Apt/Unit City Province Postal Code Home Phone(Required)Business PhoneCell Phone(Required)Email(Required) Lives with child:(Required) Yes NoHas access to child:(Required) Yes NoFamily Information (Continued)Not Applicable Parent/Guardian 2 Not Applicable (i.e. single parent or guardian)Name of Parent/Guardian 2(Required) First Last Is available for contact while child is at camp:(Required) Yes NoRelationship to the camper:(Required)Address(Required) Address Apt/Unit City Province Postal Code Home Phone(Required)Business PhoneCell Phone(Required)Email(Required) Lives with child:(Required) Yes NoHas access to child:(Required) Yes NoEmergency ContactOther than parent/guardian. This person MUST be available while your child is at camp and know your child well.Emergency Contact Name(Required) First Last Relationship to the camper:(Required)Home Phone(Required)Business PhoneCell Phone(Required)Past ExperienceEcolé Montessori Summer Reading Program is an academic program. We would like to ensure that all our students received the best support in our learning. Please answer the following questions if you feel comfortable doing so.Does your child have previous French experience? Yes NoHow many years of French experience?(Required)Is there anything we should know about your child's ability to read and write? Yes NoPlease explain:(Required)Does your child express interest in reading? Yes NoMedical InformationEcolé Montessori Summer Reading Program is an academic program. We would like to ensure that all our students received the best support in our learning. Please answer the following questions if you feel comfortable doing so.Has your child been diagnosed with any of the following? Check all that apply: ADD/ADHD Learning Exceptionalities Epilepsy Autism Spectrum Disorder (PDD) Anxiety Disorder Diabetes ODD Depression OtherDoes your child have any life-threatening allergies? Yes NoPlease list them here:(Required)Does your child carry an Epi-Pen? Yes NoDoes your child know how to use an Epi-Pen?(Required) Yes NoDoes your child have any food restrictions? Yes NoPlease list them here:(Required)Is your child currently taking any medications? Yes NoPlease list them here:(Required)Does your child have asthma? Yes NoConditions of Registration I have read, understood, and agree to all of the following statements:I give permission for the above named child to participate fully both on and off site activities and trips.I give permission for emergency medical treatment to be carried out, should it be required, with the understanding that French 4 Tots Ltd. will attempt to contact me at the telephone numbers listed on this form. Having taken all reasonable precautions, neither French 4 Tots Ltd. nor any organization working with French 4 Tots Ltd. shall be held responsible for any accident or sickness.I give permission for a representative from French 4 Tots Ltd. to share/obtain information about above named child's emergency contact as indicated on this form.I agree to the use of photographs, digital images, video or audio recordings of this child without consideration for the purposes of public education and publicity for French 4 Tots Ltd. I agree that any such photographs, negatives, slides, digital images, video or audio recordings shall be the sole property of French 4 Tots Ltd.The Camp Director reserves the right to send a camper home if in her/his opinion the camper is a risk to the safety or rights of others or who appear to have rejected the reasonable expectations of the camp.Refunds are subject to a $15.00 administration fee.There will be no refund for cancellations received 14 days or less from the start of the registered camp session.There will be no reduction or refund of camp fees for campers arriving late, leaving early, or who are sent home.The parents/guardians submitting this application are those having legal custody over the child and are legally responsible for the payment of fees and any other expenses incurred by the child.I hereby certify that I have read and accept all the above conditions. The application cannot be accepted without parent/guardian signature.I hereby release the camp organizers from all claims arising in the participation in any activity.I acknowledge that French 4 Tots Ltd. is not responsible for lost or stolen articles. French 4 Tots Ltd. collects personal information about participants in its programs to be able to communicate effectively with and provide services to, these participants and the community served by French 4 Tots Ltd. For information about French 4 Tots' Personal Information Policy, please see our website at www.french4tots.ca Completed applications are processed as received, assessed according to need, space availability and at the discretion of the Camp Director. If your application is not accepted, your deposit will be refunded. Applications with missing information will not be processed.eSignature(Required)Date MM slash DD slash YYYY NoteSummer Registration Price: Total Billing Address(Required) Street Address City Province Postal Code Credit CardCard Details Cardholder Name
