MYC

Day Camp
Summer Music Camp 2011 Registration
Week #1 July 4 – 8 (9:00 -3:30) Ages 3-10 ___
Week #2 July 11-15 (9:00 -3:30) Ages 3-10 ___

Week choice is flexible… yes_____ no_____?

Camper Information

Name of Camper: _____________________________ Age: ____________ (must be toilet trained)

Name of Parent(s)/Guardian(s): ___________________________________________T-shirt size ______

Home Phone: ________________ Work Phone: ___________________ Cell phone: ________________

E-mail: ______________________Address:__________________________________________________

Emergency Contact: ____________________________________________________________________

Grade in School: ______________________ School attending: __________________________________

Any known Allergies or medical circumstances pertinent to the camp: _____________________________

Is there anything we should know about your child? ____________________________________________

Who will be picking up your child? _________________________________________________________

Last completed MYC level or music instruction (This is not a prerequisite) __________
No previous music instruction_______

FEES
Fee includes: t-shirt, crafts, snacks, daily MYC® music lesson, daily FwC workshop, workbook, indoor
and outdoor activities and adventures, presentation for parents
Cost- $65 due with registration and remaining Camp fee of $200 due on the first day of camp.
Make cheques payable to Tracey Robinson.
Registration Deposit fee - $65.00 Remaining Camp fee - $200.00
Mail Registration Form with $65 Deposit to:
Tracey Robinson 17 Cummings Rd. Lyn, ON K0E 1M0

AGREEMENT

If I cannot be reached and my child requires emergency treatment, either because of illness or accident, I
hereby authorize Tracey Robinson to call in a physician or take my child to a hospital or physician’s office
for this purpose. Photographs or videos of my child may be included in future MYC® publications.

Child’s Health card Number: _______________________________________

Signature of Parent/Guardian ________________________________ Date: __________

For further inquiries contact Tracey Robinson (613) 498-3141 ♪lynmyc@cogeco.ca