New Registartion

Summer Camp Registration Form

Once a child is registered NO REFUNDS will be issued

Please fill out the registration form to complete the registration process.
If you have filled out this form for a previous camp this summer, please check the box below.

I have completed this form for a previous camp this summer.

Name Of Camp

Date Of Camp

Student Name

Student Address

Home Phone

Student Age

Health Card Number

Parent 1

Name

Address

Email Address

Home Number

Work Number

cell

Parent 2

Name

Address

Email Address

Home Number

Work Number

cell

Emergency Contact

Emergency Contact Name

Emergency Contact Number

Emergency Contact Email

cell

Allergies/Medical Conditions:

Does your child have any allergies?

Does your child have any life-threatening allergies?

If yes, please provide details of all allergies.

Does your child carry/require an epi-pen?

Does your child require any medication?

If yes, please provide details of all medication/epi-pens and where they are to be stored/carried.

If your child has any food allergies, please email us a picture of your child to post in the lunchroom

Other/Additional Information KA staff need to know about your child:

Authorized Pick- Up

At Kanata Academy, we require that anyone picking up your child has photo ID to show our staff prior to taking your child.If someone other than the parent(s) are picking up campers, please let them know they are required to show photo ID at pick up.

Please indicate the name of the individual(s) who are permitted to pick up your child.

Person #1:

Phone #:

Person #2:

Phone #2:

Person #3:

Phone #3: