Westpark Pool Fun Zone

                          

Childs Name: ___________________________________Phone Number:(        ) ______________________

 

Address: _____________________________________     Email: ______________________________________

 

Mother’s Name:_________________Father’s    Name: _____________________________________Cell Phone:(___)________________________________

 

Pediatrician: ________________________________Phone Number (____) __________________________

 

Medicare number: ___________________________Does the child have allergies? __________________

 

Emergency Name & Number: _____________________________________________________

 

SIN and name of Parent: (for tax receipt):

___________________________________________________

 

Date of Birth (D/M/Y): ___/___/___ Sex: _____ Grade: ____

 

Kids will be registered in swim lessons (last completed level) ____________________________

 

Would you like to be placed with a friend? ___________________________________________

 

Please circle the sessions you will be registering in:

           1           2          3            4             5           

 

Fees:       $95.00 per week for members and $140.00 for non-members (8am to 4pm)

Fees:       $50.00 per week for 2-3 year old program (9am to 12pm)

 

The additional charge for extended day is $50.00 per week

8am to 9am & 4pm to 5:30pm  

 

Will you be participating in the Lunch program ($25.00 extra per week)? Yes or No?

                     

Please submit separate checks for camp and lunch program.

Please send all checks with registration forms.

Make checks payable to “Westpark Pool”

THERE IS ABSOLUTELY NO REFUNDS ONCE CAMP HAS BEGUN!!!

THERE WILL BE NO EXCEPTIONS AT ALL!!!!