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Cowichan Art Camps

Please fill out a registration form for each participant you wish to enroll

PARTICIPANT:

Name: _______________________________ Gender : M F Date of Birth: _________________ Age:____


Home # __________________________

PARENT / GUARDIAN
Name: ________________________________________________ Relationship:____________________________

Home #: _______________________ Work #: _______________________ Cell #: _________________________

Address: _____________________________________________________________________________________

City: __________________ Postal Code: ________________ Email: _____________________________________


If possible, please check off ALL weeks that the camper will be attending.

1: Martial & Visual Arts Camp 4: Fantastic Worlds & The Creatures Who Live There
th th
Mon. July 10 Fri. July 14 (A Mythical Steampunk Adventure)
Full day: 8:30 am 3:30 pm (Martial arts, crafting and outside Mon. Aug. 14th Thur. Aug. 17th
adventures) Full day: 8:30 am 3:30 pm (art and outside adventure)
$150.00 $145.00
Half day: 8:30-11:30am (Martial arts, crafting portion only) Half day: 8:30-11:30am (art portion only)
$110.00 $105.00
Ages 5-12 Ages 8-12
2: All About The Rocks 5: Nature Projects & Paper Art
th
Tue. July 18 Thur. July 20th Mon. Aug. 21st Thurs. Aug. 24th
Full day: 8:30 am 3:30 pm (art and outside adventure) Full day: 8:30 am 3:30 pm (art and outside adventure)
$140.00 $145.00
Half day: 8:30-11:30am (art portion only) Half day: 8:30-11:30am (art portion only)
$100.00 $105.00
Ages 8-12 Ages 5-12
3: Martial & Visual Arts Camp For an additional fee there may be an option for before
th
Tue. Aug. 8 Fri. Aug. 11 th and after care if you need early/late drop off/pick up.
Please enquire.
Full day: 8:30 am 3:30 pm (art and outside adventure)
$140.00 Payment: Full payment required by first day of camp.
Half day: 8:30-11:30am (art portion only) First Come, First Served Basis. Camp space is limited!
$100.00 Refund Policy: A refund minus a $5 administration fee will be given
Ages 5-12 if notice is received 1 day prior to the first day of camp.

By Phone
2 Ways to Online 250-710-8424
Pre-Register
www.cowichanartcamps.weebly.com Bring Cheque or Cash on the first day of camp.

DATE RECEIVED
OFFICE USE: Cheque # _______ Cash

TOTAL Amount: $__________ Receipt #: __________ Note: _______________________


Cowichan Art Camps

Waiver/Release Form & Emergency Contact Information

Camper Name: _________________________________________________________

The following are the only people that can pick up your child from camp:

Name________________________________________ Phone Number___________________________

Name________________________________________ Phone Number___________________________

Name________________________________________ Phone Number___________________________

If anyone else arrives to pick up your child, you will be contacted to gain verbal permission. If it is known in advance
that someone else will be picking them up, please send a note with the child stating who they will be leaving with.

My child has permission to walk to/from camp on the following days (Initial each day they will be walking home):

Monday__________ Tuesday__________ Wednesday__________ Thursday__________ Friday__________

Emergency Contact Names and Numbers:

Parent/Guardian: _______________________ Daytime #: _________________ Cell #: _______________

Other Contact person: _______________________ Daytime #: _________________ Cell #: ________________

Childs Care Card Number: ______________________________________________________________

Please list any special needs, allergies, medical conditions, or medicines we should be aware of:
______________________________________________________________________________________

RELEASE ITEMS (By signing below you are giving your consent to/acknowledging your awareness of the following):

Awareness of Liability Disclaimer: Cowichan Art Camps and all affiliated organizers, coaches, teachers and volunteers are not liable for
any injury or mishap sustained during any camp activities. I hereby release Cowichan Art Camps and affiliates, and waive any and all claims I may
have against, and release from all liability and agree not to sue the employees, agents, volunteers and representatives for any personal injury,
death, property damage or loss sustained and resulting from participation in this program.
Initial:
Agreement to Accept First Aid Treatment: If an emergency should occur this form gives camp instructors permission to administer
first aid and/or use your childs medical number if necessary.
Initial:

Agreement to Accept Transportation: Gives permission for your child to walk to other venues being used during camp time (hikes)
by a camp leader and our daily walk to Centennial Park.
Initial:
Consent for taking Photographs: Gives Cowichan Art Camps permission to take and use photographs including your child for
promotional use (advertising) hard copy, newspaper, website, and camp-use. There is no compensation for this use. If you do not wish your childs
photograph to be used in one or more of the categories, please explain on the line provided. If you do not specify, then we will assume we have
permission to use your childs photo. Please explain limitations in photo use here:

__________________________________ ________________________________ ____________________


Parent/Guardian or Rep Printed Name(s) Parent/Guardian or Rep Signature Date