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Student's Name *

Birth Date *

Age *

Gender *

Female
Male
Prefer not to disclose

Does the student have any allergies, medical concerns, or behavioural concerns? If yes, please describe:

Address *

City *

Postal Code

Phone *

Alternate Phone

Email *

Please add me to VAM's mailing list!

Yes

Emergency Contact Name *

Emergency Contact Relationship to Student *

Emergency Phone *

Emergency Alternate Phone

PICK-UP PERMISSIONS - Anyone other than the parent or legal guardian who is authorized to sign your child out. Photo ID must be produced daily. We cannot release campers to anyone not listed on the registration form. Alternate arrangements during camp must be made in advance.

FRIENDS/SIBLINGS - If you would like your child to be in a class with a friend or friends, list their names below. Please be aware that VAM arranges the classes by age. Any group of friends or request to have siblings together will be placed according to the age of the youngest child in the group.

I CONFIRM THAT I HAVE READ AND AGREE WITH THE POLICIES AND INFORMATION LISTED IN THE COURSE DESCRIPTION *

Yes

Please sign your Name *

Date *