*Application for Summer Camp 2008*Name of Student ____________________________________OHIP Number_______________ Name of Guardian ___________________________________Birth Date__________________ Address________________________________________________________________________ Telephone Numbers:Home:____________________________________________ Office Mother :_______________________Office Father:______________________________ Mother Cell: ___________________________Father Cell: _____________________________ Family Physician : _______________________Phone : ____________________________ Allergies : _______________________________________________________________________ Previous Riding Experience: _______________________________________________________________________________ _______________________________________________________________________________ Circle the week you are Applying for :
July 7-11 July 14-18 July 21-25 July 28-Aug 1 August 11-15 August 18-22 Total payment for 5 day Camp $275.+ 5% gst. Deposit at registration is 60.00 Balance due the first day of camp.
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