Winnipeg Beach Day Camp Registration Form

Winnipeg Beach Day Camp Registration Form
Welcome to our new registration form! We are trying to cut down on our use of paper and are going digital!

The questions that have a red star next to them are required information.

If you have any questions regarding our new format please email us at winnipegbeachdaycamp@hotmail.com
CHILD INFORMATION:
Child Name (1)*

First NameLast Name
Birth Date*

MonthDayYear
Age*
MHSC # *
6 digets
PHIN #*
9 Digets
Swimming Level*
Has your child taken swimming lessons?*
Child Name (2)

First NameLast Name
Birth Date

MonthDayYear
Age
MHSC #
6 digets
PHIN #
9 Digets
Swimming Level
Has your child taken swimming lessons?
Child Name (3)

First NameLast Name
Birth Date

MonthDayYear
Age
MHSC #
6 digets
PHIN #
9 Digets
Swimming Level
Has your child taken swimming lessons?
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name (1)*

First NameLast Name
Parent/Guardian Name (2)

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Primary Phone Number*

Area CodePhone Number
Secondary Phone Number*

Area CodePhone Number
E-mail*
Emergency Contact

This contact is for emergency only if the Parent/Guardian is unavailable at this time.
Name*

First NameLast Name
Relationship to Camper*
(Ex: Grandparent, Friend, Relative, etc.)
Phone Number*

Area CodePhone Number
MEDICAL INFORMATION
Physician Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Medical Concerns*
Please indicate if your child has allergies, asthma, or other medical concerns
Dates

Pick the dates your camper(s) will be attending camp. If you choose the 10-Day Pass, you must indicate below which dates your camper will be attending as we will not be accepting drop-ins this summer!

	Attendance
Week 1: July 5th -9th
Week 2: July 12th - 16th
Week 3: July 19th - 23rd
Week 4: July 26th - 31st
Week 5: Aug 3rd - 6th
Week 6: Aug 9th - 13th
Week 7: Aug 16th - 20th
10 Day Pass

Please leave us a comment about your attendance if necessary
10 Day Pass Dates
Winnipeg Beach Day Camp - Release Wavier
Release and Waiver for*
Camper's Name
I understand that participation in outdoor camp activities
involves potential risk to my child (children) and I assume that risk on my child’s
(children's) behalf. Acknowledging this fact, and in consideration of you accepting my
child’s (children's) registration for any and all sessions attended by my child in the 2020
camp season, I hereby for myself, my heirs, executors, administrators or anyone else who
may be entitled to claim on my or my child’s (children's) behalf, covenant not to sue, and
hereby waive, release and discharge the Winnipeg Beach Day Camp Inc. and its officers
and directors and all their agents, employees, assigns or anyone else acting for or of any
kind or nature whatsoever arising out of, or in the course of my child’s (children's)
participation in the camp, other than a result of gross negligence of officers, directors or
employees of the camp. This release and Waiver extends to all claims of every kind of
nature whatsoever, foreseen and unforeseen, known or unknown. I acknowledge having
read this waiver and by signing below I am stating that I understand and accept its terms
and conditions.
Signature*

Clear
By signing below, I agree to allow my child's/ children's picture(s) to be featured in this
or future editions of the Winnipeg Beach Day Camp website, Facebook, or other such
advertising for the camp. If I do not sign, I am not providing such permission.
Signature

Clear
Date*

MonthDayYear
Registration Fees

Pre-registration ends May 3rd 2021

Pre-Registration	Regular Registration
1 Week $115	1 Week $140
2 weeks $210	2 Weeks $250
3 Weeks $310	3 Weeks $375
4 Weeks $415	4 Weeks $500
5 Weeks $520	5 Weeks $620
6 Weeks $620	6 Weeks $745
7 Weeks $725	7 Weeks $870
	10 Day Pass $290
	Pay by the day $35

Optional donation to the Winnipeg Beach Day Camp legacy fund which will be used to pay for future capital projects and equipment.
Optional Donation Amount:
Payment
We have 3 methods of payments:

1. E-transfer fees to winnipegbeachdaycamp@hotmail.com

2. Snail Mail a Cheque or Cash

Mail to Director

944 Queenston Bay, Winnipeg, MB, R3N 0Y2

Drop-off to the camp office

3. Pay On-site with cash or a cheque
What is your method of payment*

E-transferSnail MailOn-site
Discount Code:
Should be Empty:

Winnipeg Beach Day Camp Registration Form

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION:

Emergency Contact

MEDICAL INFORMATION

Dates

Winnipeg Beach Day Camp - Release Wavier

Registration Fees

Payment