Summer Day Camp registration form
Please note that this is a Specialized Summer Fun Learning Day Camp, a mindfulness-based program for children that is certified internationally using nature as the classroom to stimulate our brain as we play with movement/storytelling yoga, mindfulness practices and cultivate integration for sensory differences in children. Yoga mats and learning materials are provided daily. Each child brings their own snacks (for half day camp) and/or packed lunch (for full day camp). 

This form is for children ages 6-12 attending the Mirador Mindfulness, Yoga & Nature Immersion Day Camps  in the summer of 2024. One form is required per child (or group of siblings per family) per summer (not per week). If information will be different for different weeks, please indicate this in the "Other Comments" section at the end of the form, or email us at cezarina.trone@gmail.com; you will also be able to sign off on changes throughout the summer.

Confidentiality: The information provided on this form will only be viewed by Cezarina Trone (experienced  teacher and trainer @ Mirador Mindfulness, Yoga & Creativity School RCYS) to ensure your child's safety and a positive summer day camp experience (e.g. allergies, asthma, supervision information, support needs).


Event Timing: Starting July 1st - August 30th (9 weeks)
Event Address: Lotus Heart Centre: 448 Old Wooler Rd., Brighton ON  (20 acres of nature oasis)
Contact CEZARINA at (416) 543-4800 or cezarina.trone@gmail.com
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Hello, dear parents 
We are delighted to have your family join us for this Wonderful Child Wellbeing Adventure @ the Lotus Heart Centre in Brighton, ON.
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Learning Program Schedule

FULL DAY Summer Camp 9AM-3 PM 
Please note WEDS hours: 9:30-3:30 PM
Week 1 & 6 (4 day weeks) 
Week 2,3,4,5,7,8,9 (5 day weeks) 


* Please note that yoga mats and learning materials are provided daily. Each child brings their own snacks (for half day camp) and/or packed lunch (for full day camp). 
Extended hours 

Extended hours are available for families who require care before or after our regular hours of 9:00 am & 3 pm. Extended care is provided at the Lotus Heart Centre between 7 am and 4:30 pm daily (except on selected Friday afternoons). Please write down your hours.

* Before Care (7:30 am to 9:00 am) $75 full week / and $60 week 1 & 6 
*After Care (3:00 pm to 4:30 pm) $75 full week / and $60 week 1 & 6 

*Before & After Care  $140 full week / $112 week 1 & 6
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Please select the Week(s) or Days you are registering for:  (example: write down week 1& 6, or 9 weeks (choose a day each week): *
Parent name(s) *
Address  *
Email *
City *
Postal code *
Phone number *
Children's information

Note:  Please note that this is a Specialized Summer Fun Learning Day Camp, a mindfulness-based program for children that is certified internationally using nature as the classroom to stimulate our brain as we play with movement/storytelling yoga, mindfulness practices and cultivate integration for sensory differences in children.  In order to enhance our mindful learning daily, offer support for sensory integration, and help your child release hidden stress, please consider answering the questions in the life stress inventory  (modified for children). This is not mandatory, but it will be very helpful for us. This can be done later after registration, let us know by writing "yes" or "no" on the line below.
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First child's name  *
Age and birthdate *
How often does your child spend time in nature or outdoor activities per week? *
Required
Does your child have any allergies or medical conditions we need to be aware of? If so, please share what we would need to know for this summer day camp. *
What fears or concerns (if any) might you have about your child attending a mindfulness, yoga and nature immersion camp? *
What strategies do you use at home to successfully support your child when they need help self-regulating? *
Please share any other information about your child's behavior that would help us provide the best possible experience for your child in this specialized mindfulness, yoga and nature immersion summer camp.  Specify your child's interests, special skills (does he or she like sports, art related activities, music, games, what are their fears, dislikes, etc.) *
Please explain in as much detail as possible about your participant's emotional and intellectual development and specific difficulties. The clearer understanding we have of your child, the better we can adapt a wonderful summer program to meet his/her specific needs.
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