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2018 Summer Camp Booking Form

Total number of children you would like to register for camp: (please complete one form for EACH child)*
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How many weeks of camp would you like to register for?*
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What week(s) of camp would you like to register for?*
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Why did you choose this particular week/camp(s)?
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Child`s Legal Name:*
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Sex:*
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Birthday (dd/mm/yyyy)*
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Address:*
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City:
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Postal Code:*
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Phone Number:*
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Email Address:*
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Alternate Email Address:
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Mother/Legal Guardian's Name:*
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Work Phone:*
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Home/Cell Phone:*
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Father/Legal Guardian's Name:
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Work Phone:
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Home/Cell Phone:
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Person(s) authorized to pick up your child (Must show valid photo ID):*
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Alternate Pick Up Person's Phone Number:
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Alberta Health Care Insurance Number:*
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Doctor's Name:*
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Doctor's Phone:*
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Doctor's Address:*
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Are your child's immunizations up to date?*
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If no, please explain:
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Is your child on any ongoing medication?*
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If yes, please explain:
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Does your child have any allergies?*
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If yes, please describe:
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Any special dietary concerns?
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Has your child had any medical or emotional conditions requiring treatment or supervision?*
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If yes, please explain:
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Is there any additional information you feel may help in any way?
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In the event of an accident, I give permission to Cobb's Adventure Park & Corn Maze to contact Emergency Medical Services and if deemed necessary, transport my child to a medical facility at my expense. I give permission for my child to accompany his/her class offsite in case of an emergency. I declare that the information contained in this "health record" is true and correct.*
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Alternate contact(s) to call in case of emergency Name:*
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Address:*
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Phone Number(s):*
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Relationship:*
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If there is a custody agreement please give details:
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Indicate anyone to whom your child may not be released:
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Will you require before or after care for your child? Before care is 7:30-9 am, after care is 4-5:30 pm. Before OR after care costs $30/child/week, before AND after care costs $50/child/week. *PLEASE NOTE: A $1/minute late fee is charged for all late pickups.*
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Would you like Cobb's to provide lunch and snacks for your child during camp? (Cost for the week is $60 + GST)*
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Are you interested in attending Bring your Parent to Camp Day?
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I hereby give Cobb's Adventure Park & Corn Maze permission to take pictures/videos of my child for use in advertising such as websites, newspapers and magazines. I also give permission for my child's picture/video to be taken at special events that parents are welcome to attend. I have read and understood the policies of Cobb's Adventure Park & Corn Maze. *
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We require at least two weeks notice for a full refund, less a $50 processing fee. No refunds will be given for notice of less than two weeks*
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I understand that my registration is not confirmed until payment is received. Please contact us by phone at 403-210-2676, or by email (info@cobbsadventurepark.com) to arrange payment.*
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