1. family and parenting
2. children

Pierrefonds Day Camps inc.
Registration 2015
CODE
Child’s given name: ___________________ Family name: __________________
Age: ____ Sex: M - F
Address: _____________________________________________
Apt: ______
City: ______________________
Postal code: _____________
Tel: ______________________
Date of birth: ____ / ____ / ____
D
M
Medicare card #: ___________________ Exp.: ______________
Y
E-Mail:___________________________________________________________________________________
Health requirements/concerns: Yes No Epilepsy Asthma Hyperactivity Allergies ______________________Medication: _____________
Dosage:_______________
Special needs or Specific requirements: _________________________________________________________
NAME
Parent (1) name:
Tel (office)
Cellular
________________________
_________________
_____________________
Parent (2) name: ________________________
_________________
_____________________
Parent (3) name: ________________________
________________
_____________________
Parent (4) name: ________________________
________________
_____________________
Emergency contact: _______________________
_________________
_____________________
Departure of the child: Solo
: MOM
: DAD, With another adult Name: ____________________
Swimming pool: I give authorization for my child to swim in all sections of the swimming pool: YES
Sunscreen: I authorise the day camp to help or apply sunscreen to my child:
YES
NO
NO
Please be in the same group as: ____________________________ ___________________________
Income tax receipts: Parent’s name: __________________________
S.I.N.: _____________
% ______
Income tax receipts: Parent’s name: __________________________
S.I.N.: _____________
% ______
Baby
sitting
St.Anthony
5-8
Beaubois
5-12 yrs
Creative
Beaubois
5-12 yrs
Chalet
Roxboro
5-12 yrs
Thorndale
5-12 yrs
Creative
PCHS
5-12 yrs
35$
week
1
2
3
4
5
6
7
8
9
June29
July.3
July
6-10
July
13-17
July
20-24
Jul.
27-31
Aug
3-7
Aug
10-14
Aug
17-21
Aug
24-28
PCHS
5-12 yrs
Adventure
1.PCHS
2. St. Anthony
3.Beaubois
3 or 5 days
Teen
13-15 yrs
PCHS
3 days
St. Anthony
Only
Total $
Reg.
Fee
25$
NOTE: I agree to give my child’s Medicare card #, as well as the S.I.N. number for income tax purposes to the day camp administration. I
understand that this information will remain confidential. In case of error in calculation upon registration, the day camp administration
reserves the right to make the necessary correction(s) on this form, according to the 2015 costs. Any changes made to my file after June
15th will result in a 10$ change fee. The NSF fee is 40$. I declare that the information on this form is true and correct to the best of my
knowledge. In case of missing information, a review of the case file will be done. I have read and understand all the rules and regulation
pertaining to Pierrefonds Day Camps inc. summer 2015 program. I agree to comply with all clauses pertaining to this document.
I understand that due to the short-term program, NO refund is available due to reservation fees and hiring staff.
□
I authorize Pierrefonds Day camp inc. to take pictures for camp activities only □
Parent’s signature: ___________________________________
Reserved for administrative use:
th
th
Cash
Date: _______________
Cheque
April 30 _______________ May 30 ___________________
th
May 15th ___________________June 15 _________________
Registration________
Babysitting___________
PIERREFONDS DAY CAMP INC. INFORMATION & REGULATIONS - SUMMER 2015
REGISTRATION FEES:
A mandatory $25 fee is required upon registration. Please write a separate check or cash (nonrefundable), payable to: Les Camps de jour Pierrefonds Inc.
NO REFUND:
This being a short term program, no refund is available due to fixed pre reservation fees and hiring of the staff
purchasing supplies equipment t-shirts etc. all based on registration numbers..
RATES:
Rates for several children apply only for children of the same family. They must attend the program during the same
weeks. No family discounts apply to the specialized camps, Teen or Adventure camp.
METHODS OF PAYMENT (non-refundable): Cash or cheque
th
th
th
th
th
th
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Ä March 15 -30 , April 15 -30 , May 15 -30 , June 15
Possible Payments:
T-SHIRT:
For security purposes a t-shirt will be given to each child after payment of the mandatory registration fee. The t-shirt is
compulsory for all children when going on outings. If your child does not have the t-shirt, a letter will be sent home in
order to inform you that if your child is not wearing the t-shirt on the following outing, your child will be denied access to
the outing.
Note: In case of loss, the t-shirt will have to be replaced at the cost of $15.
N.S.F. CHECK:
A $40 charge is applicable in case of N.S.F. checks.
Note: The child will not be accepted at camp until cash payment is received.
BABYSITTING:
A babysitting service is offered between 7am and 8:30am and between 4:30pm to 6:30pm.
Babysitting packages (non- transferable and non- refundable) are available.
Cost: (before april 5th) Full week = $30 / week Mornings = $12 / week Evenings = $18 / week
Cost: (regular) Full week = $35 / week Mornings = $15 / week Evenings = $20 / week Occasional = $4hr
After 6:30 PM = $1 / each minute of delay to be paid cash immediately
Note: These fees apply to families; however they are only applicable for children from the same family.
Children present 6 minutes before 8:30am or after 4:30pm must pay for half an hour.
ABSENCE / DEPARTURE: Please note that days missed will not be refunded. A written permission slip will be required if your
child needs to leave the park alone before 4:30PM.
CHANGE OF PARK/WEEKS:
All requests to change the park or week chosen must be made through the administration,
Please note that all changes made to your child’s registration will result in a $10 charge each
time after June 15th. Unused weeks are not transferable to another child.
UNDUE DISTURBANCE OF THE GROUP:
CHILDREN WITH DISABILITIES:
LOST & FOUND:
FOOD:
We offer children with special needs the opportunity to participate in an integrated day camp
program. Your child must be accompanied by a companion at all times.
Please note: Your registration will be reviewed by WIAIH before being officially accepted.
Places are limited. There is limited access for wheelchairs.
The day camp is not responsible for any lost and/or stolen articles at the different sites. We strongly suggest that
all articles and clothes be identified. All valuables need to be left at home.
No toys, games, cards, MP3’s, cellular can be brought to camp unless otherwise specified.
Due to allergies, we do not allow the children to have peanut butter or food with traces of peanuts, nuts in their lunches.
DAYS OF CAMP:
OUTINGS:
Parents will be advised of any inappropriate behaviour on the part of their
child. In the event that there is no noticeable improvement after notifying
the parents, the administration reserves the right to expel a child who would
jeopardize the security of the group. Administration charges of 20% and
registration fee will be retained if a refund is warranted,
5 days = Monday to Friday Includes outing
No special forfeits will be accepted
The outings are scheduled on the Wednesday, except when otherwise noted. In case of rain and/or cancellation, the
Outing will be on the Friday, rain or shine. It is very important that your child is on the site at 8:30am
CAPACITY:
N.B. A minimum of 20 children is required for the opening of a site.
West Community Centre (St-Anthony):
Regular camp: 60 children (5-8 y.o.)
Ratio: 1/10
Adventure Camp: 44 children
(10-13 y.o.)Ratio: 1/10
College Beaubois:
Regular camp: 60 children
Art camp:
24 children
Adventure Camp: 44 children
Roxboro chalet:
Regular camp:
60 children
(5-12 y.o.) Ratio: 1/10
PCHS:
Regular Camp:
Art camp:
Teen
:
Adventure
60 children
44 children
44 children
44children
(5-12 y.o.)Ratio: 1/10
(5-12 y.o.) Ratio: 1/10
(13-15 y.o) Ratio: 1/11
(10-13y.o) Ration: 1/10
Regular Camp:
48 children
(5-12 y.o.) Ratio: 1/10
Thorndale:
This document refers to the 2015 summer pamphlet.
The present document is a contract and has legal value
(5-12 y.o.) Ratio: 1/10
(5-12 y.o.) Ratio: 1/10
(10-13 y.o.) Ratio: 1/10