Location Attending: *

Which location is your child attending our camps:

Sprouts - 183 Carlaw Ave. (4-8 yrs)

Sprouts Maker Space & Tech Lab - 388 Carlaw Ave Unit 101A (8 years +)

Fayez 1 Dance Camp - 388 Carlaw Ave Unit 201

Before Care Needed? 8am start $15/day

Monday

Tuesday

Wednesday

Thursday

Friday

After Camp Care Needed? til 6pm $25/day

Monday

Tuesday

Wednesday

Thursday

Friday

Camper's Name *

First Name

Last Name

Birth Date *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Name: *

First Name

Last Name

Cell Phone

(###)

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Home Phone

(###)

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Work Phone

(###)

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Parent/Guardian Name

First Name

Last Name

Cell

(###)

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Work

(###)

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Address (if different from above)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergncy Contact / Authroized for Pick Up

First Name

Last Name

Contact Number

(###)

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Emergency Contact / Authorized for Pick Up

First Name

Last Name

Contact Number

(###)

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Waiver Forms *

Please check each waiver to agree.

Medical Waiver - I understand that in the event of an accident or illness involving my child, Sprouts staff will make every attempt to contact me and/or my partner. If, however, I or my partner cannot be reached, I hereby give Sprouts – Growing Bodies & Minds, Sprouts Maker Space & Fayez1 Dance Academy and its entire staff the authority to act on my behalf.

Off Site Permission - I give permission for my child to attend any events or excursions that take place off camp premises. Campers will not go anywhere that requires travel by transit without parental permission for each specific week.

Photographic Waiver - I give permission for my child's photograph to be taken and used for Camp activities only.

Sickness Policy - I understand that my child cannot attend camp if they are ill, and will be sent home if ill.

Date *

MM

DD

YYYY