Glendale Farms Summer Day Camp And March Break Camp Form
March Break / Summer Day Camp
Name
First
Last
Age
Date of Birth
/
MM
/
DD
YYYY
Gender
Male
Female
Address
City
Province
Postal Code
Email
Mother's Name
First
Last
Home Phone
-
(###)
-
###
####
Work Phone
-
(###)
-
###
####
Father's Name
First
Last
Home Phone
-
(###)
-
###
####
Work Phone
-
(###)
-
###
####
Emergency Contact
Home Phone
-
(###)
-
###
####
Returning Camper
Yes
No
Other Contact
Relationship
Phone
-
(###)
-
###
####
Doctor's Name
Phone
-
(###)
-
###
####
Health Card #
Allergies/Physical Disabilities/Other Information
Week Requested (For March break, please choose March break for both weeks)
March Break - March 13 - 17 2023
July 15 - July 19 2024
July 22 - July 26 2024
July 29 - August 2 2024
August 12 - August 16 2024
August 19 - August 23 2024
August 26 - August 30 2024
Second Choice (For March break, please choose March break for both weeks)
March Break - March 13 - 17 2023
July 15 - July 19 2024
July 22 - July 26 2024
July 29 - August 2 2024
August 12 - August 16 2024
August 19 - August 23 2024
August 26 - August 30 2024
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