Professional Documents
Culture Documents
Summer Week of Fun Registration Form
Summer Week of Fun Registration Form
REGISTRATION FORM
Name: _________________________________________
Age: __________________________________________
Birthdate: ______________________________________
Address: _______________________________________
______________________________________________
Telephone Number: ______________________________
Emergency Contact (Name):________________________
Phone Number: __________________________________
(Alternate Contact)
Doctors Name: _________________________________
Doctors Phone Number: __________________________
ALLERGIES (Be Specific): ________________________
Care Card Number: ______________________________
***Please indicate if there is anything else you would like the staff to know.
_________________________________________________________________________________
I consent to have my child participate in the Uvic Family Centres Summer Week of
Fun Program.
____________________________________
_______________________
(PARENT / GURADIANS SIGNATURE)
(DATE)
________________________________________________
(Please print Parents Name)