Children's Information				Medical Information
Child's Name			Health Card Number
Gender: M or F	MaleFemale		Location
Grade in September			Date of Birth
Allergies / Puffers / Special Needs / Any Instructions (ADD, ADHD, PDD, AUTISM) / Comments:*
CONTACT INFORMATION
Home Address
Home Phone
Contact Email*
Contact	Name		Cell or Home		Email
Mother
Father
Emergency
Relationship
ENROLLMENT FEES INFORMATION
WEEK	START DATE	END DATE	$300/WK 9AM-3:30PM	POST CARE 3:30PM-4:30PM (FREE)	Cost
1	July 07	July 11			$0.00
2	July 14	July 18			$0.00
3	July 21	July 25			$0.00
4	July 28	August 01			$0.00
Total Number of Weeks			0
Administration Fee $50/Child:					$50.00
Subtotal					$50.00
HST 13%					$6.50
Total Fees:					$56.50

FIELD TRIPS COST: Field Trips where we have to buy tickets and Transportation would be extra charges, collected with the permission forms during camp time only.
PHOTO RELEASE FORM: I hereby authorize **Star Shine Kids** for the reproduction or display of my child’s (ren) artwork, photography, film, or audio recording for their current and future use in newsletter, website, and advertisement.
MEDICAL CONSENT STATEMENT: I authorize **Star Shine Kids** to administer first aid to my child(ren) in an emergency as deemed appropriate and release their medical information to the attending physician/hospital.
CONSENT FORM: I authorize **Star Shine Kids** to take my child(ren) on walking trips to the neighborhood, picnic, parks or other points of interests appropriate to their age group. I agree that the choice to participate in some indoor and outdoor activities brings with it the assumptions of those risks and results, which are part of these activities. I agree that **Star Shine Kids** shall not be liable for any injury to my child(ren) or loss or damage to my child(ren)’s personal property arising from, or in any way resulting from my child(ren)’s participation in these activities.
REFUND POLICY: All deposits are Non-Refundable as their purpose is to confirm that your child will be attending the summer camp & that a spot will be reserved for them at **Star Shine Kids** for the above agreed weeks.
**Star Shine Kids** reserves the right to dismiss a student if we feel the child is not fully independent (Potty Trained) and requires one-on-one supervision. In this case, any future payments owing will become null & void & the service agreement will be dismissed. **Star Shine Kids** will also agree to refund the complete deposit as well as any remaining monthly tuition that may be remaining

Signature*