2020 March Break Registration

 

PLEASE READ OUR CAMP SAFETY POLICY!

CLICK HERE


Becoming a member is a great way to save on your camp fees!


Membership Options




Registration is a two step process:

STEP 1: Registration Form ~ Please ensure that you press “SUBMIT REGISTRATION” at the end of the form before proceeding to payment.


STEP 1: REGISTRATION FORM

CHILD AND FAMILY INFORMATION

CHILD'S FIRST NAME:
*REQUIRED FIELD

CHILD'S LAST NAME:
*REQUIRED FIELD

BIRTHDATE YYYY-MM-DD:
*REQUIRED FIELD

CHILD'S ADDRESS:

*REQUIRED FIELD
CITY:

*REQUIRED FIELD
POSTAL CODE:

HOME PHONE NUMBER:
*REQUIRED FIELD

RESIDES WITH:
*REQUIRED FIELD


PRIMARY CONTACT:
*REQUIRED FIELD

RELATIONSHIP TO CHILD:
*REQUIRED FIELD

DAY PHONE NUMBER:
*REQUIRED FIELD

CELL PHONE NUMBER:
*REQUIRED FIELD

EMAIL (USED TO SEND OUT CAMP INFORMATION):
*REQUIRED FIELD

SECONDARY CONTACT:
*REQUIRED FIELD

RELATIONSHIP TO CHILD:

DAY PHONE NUMBER:
*REQUIRED FIELD

CELL PHONE NUMBER:
*REQUIRED FIELD


EMERGENCY CONTACTS (IF PRIMARY OR OR SECONDARY CONTACTS CANNOT BE REACHED). AN ADULT 16 YEARS OR OLDER WHO CAN ASSUME RESPONSIBILITY FOR THE CHILD).
NAME:
*REQUIRED FIELD

RELATIONSHIP TO CHILD:
*REQUIRED FIELD

DAY PHONE NUMBER:
*REQUIRED FIELD

CELL PHONE NUMBER:
*REQUIRED FIELD


AUTHORIZED PICKUP:
NAME OF PERSON(S) WHO CAN PICK UP CHILD (IF APPLICABLE) OTHER THAN PRIMARY OR SECONDARY CONTACTS OR EMERGENCY CONTACTS:
*REQUIRED FIELD

DO YOU GIVE US PERMISSION TO TAKE PHOTOS OF YOUR CHILD FOR PROMOTIONAL PURPOSES? NAMES WILL NOT BE USED.YESNO


INDIVIDUAL CAMPER INFORMATION

Indicate if came experiences or has experienced any of the following:

ALLERGIES:YESNO
IF YES, INDICATE TYPE:

MEDICAL: (ie: Vision/hearing/seizures/Diabetes/Mobility:

ASTHMA:YESNO
INHALER:YESNO

CURRENTLY TAKING MEDICATION?YESNO
IF YES INDICATE TYPE:

DEVELOPMENTAL/LEARNING: (ie: ADD/ADHD/Autism/Delays):YESNO
IF YES INDICATE DETAILS:

DOES YOUR CHILD REQUIRE ADDITIONAL ASSISTANCE? YESNO
If yes indicate if there is anything we should know concerning school, relationships, learning abilities, etc?

DOES YOUR CHILD REQUIRE AN EA AT SCHOOL? YESNO
IF YES, PLEASE INDICATE IF AN EA HAS BEEN ARRANGED FOR CAMP (Camp policy states that if an EA is required at school then an EA must also accompany your child during camp).

IS YOUR CHILD IMMUNIZED?YESNO

PLEASE CHECK TO INDICATE YOU HAVE READ AND UNDERSTAND THE CAMP POLICIES AND SAFETY GUIDE.

Yes I have read the Camp Safety Policy.

CLICK ON THE BUTTON BELOW TO SUBMIT YOUR FORM. PLEASE NOTE THAT PAYMENT IS A SEPARATE STEP THAT IS PROCESSED THROUGH PAYPAL. REGISTRATION CANNOT BE COMPLETED WITHOUT BOTH THE COMPLETED REGISTRATION FORM AND PAYMENT.


STEP 2: Payment ~ Add to Cart buttons selected will take you directly to PayPal.  If you do not have a PayPal account, please choose the “Check Out – Pay without a PayPal account” button on the shopping cart page.

CONFIRMATION: Once the registration form and payment have been submitted, you will receive a confirmation email from Glenhyrst.  This is not an automatic email, and will be sent as soon as possible following your registration.

If you have any questions or require assistance, please call the Gallery at 519-756-5932.

*PAYMENT WILL OPEN IN A SEPARATE PAGE. PLEASE KEEP THIS PAGE OPEN TO COMPLETE REGISTRATION.*

Junior Sign-up – Ages 4-6


Registration Fees
DAYS ATTENDING & CHILD’S NAME:



Intermediate Sign-up – Ages 7-9


Registration Fees
DAYS ATTENDING & CHILD’S NAME:



Senior Sign- up – Ages 10-12


Registration Fees
DAYS ATTENDING & CHILD’S NAME: