Form 1 Summer Camp - New Students KINDLY PRINT THIS FORM , SIGN IN ALL PLACES AND HAND IN TO JACKIE FOR THE REGISTRATION TO BE COMPLETE. BY ADDING YOUR EMAIL ADDRESS IN THE "FAMILY EMAIL ADDRESS" BOX IT WILL BE SENT TO YOU READY FOR PRINTING AND SIGNATURE Program Selection Preference * Half Day Program 9:00 – 12:00 Extended Program 9:00 – 3:00 Early Drop Off Required (8:30) Late Pick Up Required (12:30/3:30) Weeks * July 2-5 July 8 – 12 July 15 – 19 July 22 – 26 July 29 – Aug 2 Aug 6 – 9 Aug 12 – 16 Aug 19 - 23 Child Information Sex: Female Male Child's Name Home Tel: Known as (if different from given name) Date of Birth (DD/MM/YY) Address City Postal Code Languages Spoken Toilet Trained Yes No Family Information Father's Name Occupation Business Address City Work Tel Cell Tel Email Mother's Name Occupation Business Address City Work Tel Cell Tel Email Sibling Name Date of Birth (DD/MM/YY) Sibling Name Date of Birth (DD/MM/YY) Alternate Caregiver's Name Family information we should be sensitive to? Pleas list any special needs which may interfere with child's full perticipation or require special attention Emergency Information Details (specify severity of reaction) Medication Restrictions/Allergies Yes No Specify Food Restrictions/Allergies Yes No Specify Physical Disability Yes No Specify In case of emergency, if parents cannot be reached, please contact Name Tel Cell Name Tel Cell Child's Doctor Tel Address City Child's Health Card Number Should they be unable to reach me, this is to certify that I permit Thornhill Nursery School & Kindergarten to seek medical treatment for Parent Signature Date (DD/MM/YY) Family Email Address *
