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REGISTRATION FORM
  How did you learn about Francouest camp?*

School
Library
Newspaper (PLS, specify)
Word of mouth
Mon guide des loisirs
Brochure
Sign (PLS, specify the location)
Referred by a friend, PLS, enter your reference code
Other (PLS, specify)

  Information about the camper   

   Last Name*    First Name*
   Sex*        Male        Female
   Age*      Date of birth*:    day   month   year
   Attended School*
   Health Card #*
   Medical information
  

  Parent information

   Mother's Name*
   Work Phone*    Home Phone*
   Father's Name*
   Work Phone*    Home Phone
   Email*
   Re-enter email*
   Address*
   City*    Postal Code*

  Resource person (For emergency & departure)

  Name  Phone

  Locations* (Pls, tick your choice)

BELLS CORNER - 411 Seyton Drive, Nepean, ON, K2H 8X1 (C.c. Franco-Ouest)
CARLINGWOOD - 207 Woodroffe Avenue, ON, K2A 3V1 (W. U. Church)
NEPEAN - 2093 Bel-Air Drive, ON, K2C 0X2 (E.P. Charlotte-Lemieux)
NEPEAN - 159 Chesterton Drive, Ottawa, ON, K2E 7E6 (E.S.P. Deslauriers)
STITTSVILLE - 5473 Abbott East St, ON, K2S 0A8 (E.e.c Jean-Paul II)

  Cost*

Immersion Camps: 185$ / Week / Camper
   ($45: Non Refundable Deposit/ Administration Fee + $140: Participation Fees)

  Please, tick to choose the week*

Week 1
Week 2
Week 3
Week 4
Week 5
Week 6

  Discount (Tick if applicable)

  Family : I want a $10 discount per week per additional child
  Enrollment for all available weeks : I want 10% discount
  Refer a friend program: $10 discount. Enter your reference code

  Pre- and post-childcare from 7:30-9:00 a.m. till 4:00-5:00 p.m. for 20$/ Day
   PLS, contact us 24 hours in advance to reserve a place.

  (Tick if applicable)

Week
Day
 
Mo
Tu
We
Th
Fr
1
2
3
4
5
6

  Method of payment*

   The Non Refundable Deposit/ Administration Fee is payable at the moment of registration. If
   you are to make a post dated cheque, please, prepare two separate cheques one of which
   is for the Deposit/ Administration Fee dated the day of registration and the second is the
   post dated one for the Participation Fees.

I attach a cheque of $
   Mail the Registration Form and your cheque (payable to Centre communautaire
   Franc-Ouest)
I pay cash in the amount of $
   Pls, call 613-722-1819 to arrange an appointment

  Modifications & Cancellations

   Cancellations and/ or modification must be made in writing at least two (2) weeks prior to the
   week you intend to cancel. Otherwise, no refund will be issued.

   Volunteer needed

   If you enjoy being with children and like outdoor activities, we are the right place for you!
   I want to volunteer

-----------------------------------------------------------------------------------------------------------------------

   Name of the parent/ guardian*
   Date*    day   year

   PLS, the completed Form before next step.


   By clicking the button "Submit" I (parent/ guardian) confirm that I have read, understand and
   accept the terms and conditions of the program.

 
Copyright © Centre communautaire Franc-Ouest 2008 - All rights reserved