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TRANSCRIPT
Last Nam
e
City/Town
Daytim
e Phone
Relation to Camper
Email A
ddress
Address
Given N
ame
Postal Code
Cell Phone
Legal Parent or Guardian
Account N
umber
Expiry Date
Cardholder’s Nam
e
Cardholder’s Signature
Payment Inform
ationPaym
ent Method:
Total Fees for all ChildrenCash
Debit
Cam
p Fees are refund
able m
inus a $25 ad
ministration fee up
to three weeks b
efore cam
p, after that tim
e no refunds are availab
le
PLEASE N
OTE: In order to have a reserved spot, full paym
ent and returned waiver form
is required. A
receipt will be issued after full registration has been received.
For easy registration and other info please visit:
www.kids.mwpa.com
CONTACT US AT:MILL WOODS ASSEMBLY
2225 66 Street NW, Edmonton, AB
Phone: 780.462.1515Email: [email protected]
Summer 2 0 1 5day camps
Sum
mer
Cam
p 20
15 R
egis
trat
ion
Last
Nam
eG
iven
Nam
e
Gra
de
MO
NTH
/ D
AY /
YEA
R
Birt
hdat
eM
ale
Fem
ale
Sci-F
i Wee
k: J
uly
6-10
Sci-F
i Wee
k: Ju
ly 1
3-17
Boot
cam
p W
eek:
July
20-
24
Boot
cam
p W
eek:
July
27-
31
Supe
rher
o W
eek:
Aug
ust 1
0-14
Supe
rher
o W
eek:
Aug
ust 1
7-21
Child
One
KID
S K
ARE
7:30
-9:0
0 am
4:15
-5:3
0 pm
MT
WTH
F
Tota
l Cam
p Fe
es fo
r Chi
ld
Regi
stra
tion
Fee
s
Kids
Kar
e Fe
esw
eeks
X $
90X
$4 O
R � a
t rat
e =
$32
Alle
rgie
s/ M
edic
al C
once
rns/
Beh
avio
ral C
once
rns
Last
Nam
eG
iven
Nam
e
Gra
de
MO
NTH
/ D
AY /
YEA
R
Birt
hdat
eM
ale
Fem
ale
Sci-F
i Wee
k: J
uly
6-10
Sci-F
i Wee
k: Ju
ly 1
3-17
Boot
cam
p W
eek:
July
20-
24
Boot
cam
p W
eek:
July
27-
31
Supe
rher
o W
eek:
Aug
ust 1
0-14
Supe
rher
o W
eek:
Aug
ust 1
7-21
Child
Tw
o
KID
S K
ARE
7:30
-9:0
0 am
4:15
-5:3
0 pm
MT
WTH
F
Tota
l Cam
p Fe
es fo
r Chi
ld
Regi
stra
tion
Fee
s
Kids
Kar
e Fe
esw
eeks
X $
90X
$4 O
R � a
t rat
e =
$32
Alle
rgie
s/ M
edic
al C
once
rns/
Beh
avio
ral C
once
rns
Cons
ent &
Wai
ver
Are
ther
e an
y cu
stod
y co
ncer
ns w
e sh
ould
be
awar
e of
that
will
hel
p us
pro
tect
you
r chi
ldre
n?
YES
N
O (I
f YES
, ple
ase
prov
ide
deta
ils v
ia e
mai
l at k
ids@
mw
pa.c
om)
I giv
e pe
rmis
sion
for m
y ch
ild/r
en to
par
ticip
ate
in th
e pr
ogra
ms
of M
ill W
oods
Ass
embl
y. I
unde
rsta
nd th
ere
are
risks
inhe
rent
to
cam
p pr
ogra
ms
and
rele
ase
Mill
Woo
ds A
ssem
bly
from
liab
ility
for i
njur
y or
loss
rela
ted
to m
y ch
ild(re
n)’s
part
icip
atio
n an
d au
thor
ize
them
to ta
ke a
ctio
n to
pro
tect
my
child
/ren
and
\or t
o ar
rang
e em
erge
ncy
med
ical
car
e if
need
ed. D
urin
g th
e ca
mp,
pic
ture
s an
d vi
deos
may
be
take
n an
d th
ese
may
be
used
for p
ublic
ity a
nd p
rom
otio
nal p
urpo
ses.
Dat
ePr
int N
ame
Sign
atur
e
I CO
NSE
NT
I DO
NO
T CO
NSE
NT
IMPORTANT NOTES:• All camps are on-site at Mill Woods Assembly
(2225 66 Street NW, Edmonton)
• Campers need to bring their own bag lunch daily. Light snacks are provided each after-noon.
• Camps are open to children in grades one to six (2014/15 school year, Children aged 6 prior to March 1, 2015).
• Camps run from 9:00 AM - 4:00 PM.
• Drop o� begins at 9 AM and campers need to be picked up by 4 PM.
• Parents who need to drop o� their children between 7:30 and 9:00 AM, or pick them up between 4:00 and 5:30 PM, may register their children for “Kids Kare” supervision for a fee of $4 per use or a � at fee of $32.
• Registration fee is $90 per child.
Attend one or more of our
THEME CAMPSthis summer!
MONDAY- FRIDAY9 AM- 4 PMearly drop-o� andlate pick-up available
JOIN US FOR:
BOOTCAMP WEEKJuly 20-24July 27-31
SCI- FI WEEKJuly 6-10
July 13-17
SUPERHERO WEEKAugust 10-14August 17-21
Action packed games, group challenges, crafts and other activities make for a fun � lled week!
Every day includes high energy, interactive teaching times where kids learn great values!