Cabaret Kids Camp Form

Cabaret Kids Summer Camp 2017 Registration Fill in the form and mail your cheque to: Cabaret Kids, 3 Northview Place, Dollard Des Ormeaux, Quebec H9B 3K8

	Camper's Information
Campers Name:
E-mail:
Street Address:
City:
Province/State:
Postal Code:
Date of Birth:
Gender:
School:
Grade:
Home Telephone:
Cell phone:
	Mother's Information
Mother's Name:
Cell phone:
Place of work:
Work phone:
	Father's Information
Father's Name:
Cell phone:
Place of work:
Work phone:
	Secondary Contact Informationn
Name:
Relation to camper:
Phone:
Cell phone:
	Family Information
Parents marital status:
Siblings names & ages (If any)
	Camp Information
Camp hours are 9 AM - 3 PM.	Do you need extended hours? Yes No If yes, what times? (Please add amount to cheques)
Swimming level:
Previous camp experience:
Desired week(s) of attendance:
	Medical Information
Medicare / Health card # and exp. date:
Any activity restrictions:
Family doctor name:
Doctor's phone:
Appendix operated:
Chicken Pox:
Other:

	Do you give permission to Cabaret to use your child's picture or video in our brochures or web page?(Names are withheld) Yes No
Where did you hear about Cabaret Kids?:
	Hot Lunches I am registering for the B.B.Q. Wednesday $8 Friday $8 Both $16 I have sent in a payment for the B.B.Q $ Do you want kosher hot dog? Yes No I am registering for: Summer Camp Dates: June 26th – Aug 18th 2017 Session 1 (2 weeks) – June 26th- June 30th/July 3rd - July 7th. Session 2 (2 weeks) - July 10th – July 14th/July 17th -July 21st Session 3 (2 weeks) - July 24th – July 28th /July 31st - Aug. 4th Session 4 (2 weeks) - Aug. 7th - Aug. 11th/ Aug. 14th - Aug. 18th Note: show dates are Fridays: July 7th at 1:15pm, July 21st at 1:15pm, August 4th at 1:15pm, and August 18th at 1:15pm (Please indicate which weeks or sessions)
Tax receipt made out to:
Additional remarks:
	Cabaret Kids, 3 Northview Place Dollard Des Ormeaux, Quebec H9B 3K8