Summer Camp Registration Form
Summer Camp fees:
$225.00 per week for full days (8:00 am - 4:00 pm) 
$125.00 per week for half days (8:00 am -12:00 pm)

Camp is for ages 3-6, please note, registered children must be fully potty trained to attend. 

Camp Weeks
July 10-14  -Dinosaur Week
July 17-21 -Capes and Crowns 
July 24-28 - Mermaids & Pirates
Aug 14-18- All Around the World
Aug 21-25- STEM Science 

For your child to be considered registered a 50% deposit is required for each week registered.  Cancellation more then two weeks of start date will qualify for deposit to be returned.  All other circumstances are up to the discretion of Kids Time Out Executive Board

Final payment is due 2 weeks before camp start date.

Deposit can be made by E-transfer to kidstmt@telus.net (Please include child's name when sending transfer) or by cheque made out to Kids' Time Out Play Program
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Email *
Camp Weeks Attending? Choose all weeks you would like to sign up for *
Required
Child's Name (First/Middle/Last) *
Birthdate *
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Age *
Current Mailing Address *
Parent/Guardian Information: Parent 1- First/Last Name *
Parent/Guardian Information: Parent 1- Address
*
Parent/Guardian Information: Parent 1- Phone Number
*
Parent/Guardian Information: Parent 1- Email
*
Parent/Guardian Information: Parent 2- First/Last Name
Parent/Guardian Information: Parent 2- Address
Parent/Guardian Information: Parent 2- Phone Number
Parent/Guardian Information: Parent 2- Email
Emergency Contact Information: First/Last Name *
Emergency Contact Information: Address
*
Emergency Contact Information: Phone Number
*
Emergency Contact Information: Email
*
Family Physician and AB Health care # *
Does your child have allergies? *
If yes please indicate allergy and reactions:
Are there any medical issues we should know about?
Does your child take medication on a regular basis? If yes please list and state reason
Authorized people whom the child may be released to (Name and Phone #)
Parent acknowledgement:  By dating this you acknowledge you have read the Summer Camp Handbook *
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First Aid Consent:  I give permission to have first aid administered if required *
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Media Consent: I give permission for Kids' Time Out to take photographs/videos of my child for use in the classroom or for purpose of advertising and publishing on websites and brochures.  I also give permission for my child's picture to be taken at special events by other parents.
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Off Premises Consent: The above named child has my permission to leave the school premises under the supervision of Kids’ Time Out staff for nature walks and outings to local community businesses. For all of these off premises activities, the mode of transportation used will be walking only. I understand that my child will be supervised at all times and that regulated staff/child ratio will be maintained at all times. I understand that there are risks associated with the activities named above. In case of accident or any personal injury of the above named child, I hereby release and discharge Kids’ Time Out or any of its directors, teachers, employees or parent volunteers, from any claims, actions and causes of action arising from any accident or loss caused by the participation of the child named above during any activity held at this location, or during any off-premises outing or at any location where the program is held, or on route to/from any activity. Any other special excursions that rely on alternative transportation will require a separate consent form to be filled out and signed before the planned special excursion.
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A copy of your responses will be emailed to the address you provided.
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