register for summer camp

Please complete the following registration form for camp.

For families with multiple children, each child requires a separate form.

For questions, please email us.

Camper Info

Camper Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gender

Date of Birth

YYYY

Grade (in September 2025)

Allergies or Other Medical Concerns

Primary Parent/Guardian Information

Name

First Name

Last Name

Phone

(###)

###

####

Secondary Parent/Guardian Information

Name

First Name

Last Name

Phone

(###)

###

####

Emergency Contact

Name

First Name

Last Name

Phone

(###)

###

####

Pick Up

If applicable, list the names of two people authorized to sign out your child (other than a parent/guardian):

Media Release

I give permission for any photos/video taken of my child during the week of summer camp to be used for the purposes of promoting and fundraising for the Community Music School of Waterloo Region.

Agreements

• I hereby give permission for my child to participate in the Community Music School of Waterloo Region's summer camp program. • I hereby affirm that my child has no conditions that would make it unsafe for them to participate in the summer camp program. • The non-refundable camp fee of $40 is due upon registration, unless alternative arrangements are made with the Executive Director. (Please e-transfer funds to chissa@cmswr.ca.)

I have read the above and agree:

Parent/Guardian Name

First Name

Last Name

Date

YYYY

Thank you for your interest!

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