ESL Summer Camp Road Trip Registration

Calgary to Vancouver 2012

Name of Student (exactly as in passport)

Date of Birth (year/month/day)

Gender

Type of School Currently Attending

How did you find out about our summer camps?

Parent Contact Information

Parent's Names

Address of Parents

Parent's Employment

Company Name

Private Telephone

Emergency Telephone

Fax Number

Email

Who referred you to ESL Summer Camp

Course Registration Date

My child wants to register for the following course:

5 week - Calgary July 4 to Vancouver August 7
4 week - Calgary July 11 to Vancouver August 7

My child wants instruction in:

English
English and French

How many years has your child studied English

How many years has your child studied French

My child is a

non-swimmer
beginner swimmer
strong swimmer

Special Needs (example: vegetarian, special diet, diabetes, medicine, allergies, recent illness or operation)

Parent's Consent

I understand that Wynchemna reserves the right to cancel or modify any programme or programmes listed in the brochure because of an insufficient number of participants or for any other reason beyond its control. In such a case, written notification of cancellation will be sent out and the fees will be refunded.

I understand that Wynchemna reserves the right to withdraw participants whose behavior is likely to affect the smooth operation of the programme or adversely affect the enjoyment or safety of other participants. Wynchemna will be under no liability to such persons. If a child has to be sent home on disciplinary grounds, the parents will be required to pay for any costs incurred.

Experience has shown that in connection with recreational activities there are times when illness or accident may occur and immediate surgical or medical attention is necessary.

I give permission for the official in charge to make arrangements for surgical or medical attention for my child/ward in the event of an emergency without necessity of my prior approval. I understand that I will be notified by the quickest means possible if this authority is exercised.

Some of the activities listed in the brochure (for example, rock climbing) require an adult to sign liability waiver-forms.

I give permission to the Wynchemna Instructor to sign a waiver-form for my child.

I understand and permit that my child may have his or her photograph taken, and that these photographs may be used for advertising or other purposes by Wynchemna (for example, in brochures or on its website).

Prevent Spam (please enter characters)

ESL Summer Camps