Summer Camp Registration
Date: July 16-29th, 2023 (Grade 8-12)
Address: 11295 Mellis Dr, Richmond, BC V6X 1L8
Contact us at +1(236)-881-8095
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Student's Full Name *
Preferred Name
Grade *
Date of Birth
*
MM
/
DD
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YYYY
Gender
*
Home Address *
Phone Number *
Email *
Do you have any medical conditions which may require special care? *
Do you have any allergies?
*
List any dietary restrictions you have
*
Parent/Guardian #1 Full Name
*
Parent/Guardian #1 Contact Information (phone number and/or email)
*
Parent/Guardian #1 Address (if different from student)
Parent/Guardian #1 Relationship to Child *
Parent/Guardian Full Name #2
Parent/Guardian Contact Information #2 (phone number and/or email)
Parent/Guardian #1 Address (if different from student)
Parent/Guardian #2 Relationship to Child
If using an agent, please list the company name below
I understand that I will have to pay the camp fees via bank transfer or wire transfer (please contact us to make the payment of $4200/person) *
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