SUMMER BAND CAMP
2018 Application Form

CCU Summer Band Camp is a two-week music campfor children in grades K-8.
This program runs Monday to Friday for two weeks.
Registration for this camp is $500.

If you have further questions, please contact:
the Christ Church office at905-822-9834 or by email at

Start Date: / July 2, 2018 / End Date: / July 13, 2018 / Registration Deadline: / June25. 2018
Camper Name: / Likes to be Called:
Gender: / Birthday: / Age: / Sept. School Grade:
Parent/Guardian Name: / Relationship:
Address:
Phones- Home: / Cell: / Work:
Email Address:
Parent/Guardian Name: / Relationship:
Address:
Phones- Home: / Cell: / Work:
Email Address:
Who will be picking up and dropping off the camper each day?
Name: / Phone: / Relationship:

Regular day camp programming begins at 9:00am and ends at 4:00pm. For those who need it, early drop off will begin at 8:30, and late pick up will extend to 4:30pm. Please indicate if you will be taking advantage of this service, and approximately what time:

Early Drop Off ☐ Time: / Late Pickup ☐ Time:

Musical Experience:

Has the camper played an instrument before? / / Instrument:
For how long have they played? / RCM Grade Level:

How did you hear about CCU Band Camp? (Check any that apply!)

☐Through a relative/friend who attends Christ Church☐The Church Sign

☐I’m a camper from CCU Jazz Band Camp!☐Clarkson Corners

☐Through a hand-out distributed at my child’s school☐Online at

Youth T-Shirt Size:

Medical Information

Health Card Number:
Allergies or other health concerns?
Does the camper have any medications he/she needs to bring to camp daily?
(Puffers, EpiPen, Mealtime Meds, etc.) /
If Yes, please list medications:
Dosage & Frequency?
Drug Administration: /
Special Needs:
Family Doctor: / Phone #:

Emergency Contact:

Name: / Relationship:
Phones- Home: / Cell: / Work::

Permission for Emergency Medical Attention:

I/We:
Give permission for:

to receive emergency treatment from the Christ Church United Day Camp or Church Staff if it is deemed necessary. Efforts will be made to contact the parent or guardian before permission for treatment is given.

Parent/Guardian Permission to Participate:

I/We:
Give permission for:

to fully participate in Christ Church United Summer Band Camp, held in Mississauga, ON.
Participation will include physical activities both inside and outside of the church location, as well as photography and video for church purposes.

There is a $150.00 non-refundable deposit required upon registration.
The balance is due by the first day of camp.

Signed: / Date:

Parent/Guardian Signature

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Office Use Only

Deposit Paid: Yes ☐ / Cash☐ Cheque: ☒Number:
Remainder Paid On: