Registration Form for L'Imagier's Art Day Camp 2024

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Please complete the online registration form. A member of the team will contact you to confirm your chosen dates and send you a link to proceed with payment (online or by phone). Registration is finalized once payment is received. Online and phone payments must be made by credit card.

Email *

Child's first and last name *

Gender

Female

Male

Nonbinary

Clear selection

Birth date *

YYYY

Spoken languages

English

French

Bilingual (French and English)

Other:

Clear selection

Main address of the child *

Chosen dates *

July 2 - 5 | My Place in the World

July 8 - 12 | Head in the Clouds (FULL)

July 15 - 19 | My Story in Pictures (1 places left)

July 22 - 26 | Best of

July 29 - August 2 | My Place in the World

August 5 - 9 | Head in the Clouds (Last Chance!)

August 12 - 16 | My Story in Pictures

August 19 - 23 | Best of (FULL)

Required

Parent/Guardian 1 information (first and last name (address if different from child's), phone numbers, email) *

Parent/Guardian 2 information (first and last name (address if different from child's), phone numbers, email)

Person(s) to contact in case of emergency (first and last name, phone numbers, email) *

Person(s) authorized to pick up the child (first and last names) *

Allergies (Be specific! Describe situations that could cause a life-threatening allergic reaction)

Diseases or conditions (Be specific! Describe situations that may cause a medical episode)

List of medications to be given to your child (Be specific! Name of the medication, expiration date, dosage, administration and contraindications)

PARENTAL CONSENT - ADMINISTRATION OF MEDICATION

I have requested that medication (such as an Epipen injection) be administered to my child in the event of a life-threatening emergency and life-threatening emergency, and requested any of the other life-saving measures mentioned above.
mentioned above. I agree that my child may carry any of the above medications at all times during his/her stay at camp.

I agree to provide an updated medical statement should it become necessary to change the medication or dosage while my child is attending camp.

While the day camp team will make every effort to ensure that the environment is free of allergens, I understand and agree that
Although the day camp team will make every effort to ensure that the environment is free of allergens, I understand and acknowledge that L'Imagier cannot guarantee that my child will be in an environment that is completely free of allergens.

I consent to the administration of medication by the day camp team *

Yes

Other:

I authorize my child to participate in walks in the Cedar Park (500 m from L'Imaginaire Park). If a parent does not want his or her child to participate in the walks, he or she may stay at L'Imagier and do free activities. *

Yes

Required

PARENTAL CONSENT - PROMOTIONAL MATERIAL

I agree that my child may be photographed or videotaped during his or her participation in the Centre d'exposition L'Imagier's day camp and that the latter may use and broadcast these photographs or videos. The works made by the child during his or her participation in the day camp could also be diffused, with the consent of the parent.

I agree to have my child photographed *

Yes

I authorize L'Imagier to use and diffuse photographs of my child and his works. *

Yes

RELEVÉ 24 – CHILD CARE EXPENSES

For your information, L'Imagier will produce the 'Relevé 24'* which will be sent to you by email, unless otherwise specified. Your SIN will be requested after your child's participation in the day camp this summer.

* 'Relevé 24' must be filed by any person who has offered, in Quebec and for remuneration, child care services that give right to the tax credit for child care expenses. This is the case for a person who operates a daycare, a boarding school, a summer camp, a day camp or a preschool education center. 'Relevé 24' contains the information of the claimant parent, the eligible child, the amount and the number of hours or weeks of child care expenses. According to section 58.1 of the Department of Revenue Act, the sponsor must indicate his/her social insurance number in the box identified on the payment form. Failure or refusal to provide this number may result in a penalty to the individual and to the person who is required to file a statement on his or her behalf.

First name and last name of the parent (Relevé 24)

Social Insurance Number (SIN) of the parent (Relevé 24)

A copy of your responses will be emailed to the address you provided.

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