Personal Information
Student Name:
Student Age:
Alberta Health Care number:
Grade in September:
Parent/Guardian:
Street address:
City and province:
Postal code:
Home phone:
Work phone:
Email Address:
*
Cell Phone:
Emergency Information
Please list an emergency contact other than parent or guardian:
Emergency contact number:
Medical conditions/allergies:
No
Yes
Please specify:
Payment Information
Camp Dates:
Select the Camp and applicable age range
July 5-9 (Grades 1-6)
July 12-16 (Grades 7-12)
July 19-23 (Grades 1-6)
August 9-13 (Grades 7-12)
Class Fee:
Select the Class Fee
Full Day - $175-Early Bird rate ( before May 30th)
Full Day - $225 regular rate
Half day - $115
Class Hours
Full day is 9am - 4pm
Half day is 9am - noon or
1pm - 4pm
Interested in other disciplines, please check all that apply.
Filmmaking
Dance
Singing
Art
Family Discount:
Enter full name of first child in family, registered.
(10% discount applies to 2nd and successive registered family members.)
Credit card information:
Visa
MasterCard
(Sorry, no Discovery card)
Card number:
Security code:
Card expiry date:
MM/YY
Name on card:
Marketing Information
How did you hear about us?
