online summer registration @ Ross Creek

SummerArts Online registration Apply for Summer Arts at Ross Creek This form takes registration information but no payment other than the $55 non-refundable deposit. If you choose to submit your application online, once we receive it we will call or email you to make arrangements for the remainder of your payment. At the end of the form we do ask for your payment preference and with online registration, we will invoice you for the total payment or installments. If you have any questions, please email mail@artscentre.ca or call us at (902) 582-3842
General Information
Camper's Last Name	Camper's First Name	Known As
Male Female	Date of Birth	Camper's Age
Mailing Address	City	Province/State
Postal/Zip Code	Home Phone	COUNTRY
Emergency Phone #	Primary Household E-Mail

Mother/Legal Guardian Name	Mother/Guardian's Occupation	Mother/Guardian's Workplace
Mother/Guardian's Work Number	Mother/Guardian's E-Mail Address	Mother/Guardian's Cellphone #
Father/Legal Guardian Name	Father/Guardian's Occupation	Father/Guardian's Workplace
Father/Guardian's Work Number	Father/Guardian's E-Mail Address	Father/Guardian's Cellphone #
Name of Camper's School	Name of Camper's Art/Drama Teacher	Grade Camper Completed by June
Has Camper previously attended a Ross Creek Progam? Yes No	If Yes, what years/programs?	Are you applying for a Bursary? Yes No If YES please download our Bursary Form and mail it in with the req'd letters.

Camp Selection
Choose your camps!

Juniors' Week Long Camps

Junior Programs (ages 5 -7 )
These are day programs only,
and run Monday through Friday

Please Check all you wish to attend
Planet of the Gods-- July 4-8
RainForest Explorer-- July 11-15
Mighty Monsters-- July 18-22

SummerArts Camps
Intermediate (ages 8-10) and Senior (11+) Programs
You can choose from Day or overnight programs,
though we recommend overnight for the full camp experience.

SummerArts Session One
for Campers ages 8-11+
July 3-8

SummerArts Session 2
for Campers aged 8-11+
July 10-15

SummerArts Session3
for Campers ages 8-11+
July 17-22

Teen Academies
for Campers aged 14-18)
July 26-Aug 6

T-Shirt Size

Cabin Requests

We can't guarantee cabin requests, but will do our best
to accommodate camper's wishes.

How did you hear about our programs?
Please select all which apply.

From another camper

From a friend

From a school

From an e-mail

Our website

Other

Camper's Health Information EVERY CARE WILL BE GIVEN TO THE HEALTH AND COMFORT OF THE CAMPER. In order that the staff may provide the best care for your child, the following information MUST be filled out.
Health Card #	Expiry
Province	Other/Private Health Insurance Other/Private Health Insurance #
Family Doctor	Family Doctor's Phone Number
Does the camper have any dietary restrictions? None Vegetarian Vegan Doesn't eat red meat Lactose intolerant Wheat allergy Glutan free diet	Is there anything else we should know about the camper's eating habits or restrictions?

Personality

We are interested in providing a positive summer camp experience for your child. To do this, we need to prepare as well as we can for your child and ensure their comfort. Please answer the following questions if your child will be with us overnight. Indicate with a check which of these best describes your child
(check as many as you need):

Shy
Makes friends easily
Emotional
Sensitive
Easy-going
Nervous
Happy
Wets the bed
Gets homesick
Has stayed at an overnight camp before
Likes going to sleepovers with friends
Other:

Medical Conditions
Does the camper have any chronic medical challanges?
Yes No
(If they take any ongoing medications , the answer is yes.)
------------------------------------------------------------>

If Yes, please detail the condition. (i.e. diagnosis, treatment including medications, any possible restrictive activities):

Mental Health Issues
Does the camper have any behavioural or mental health challenges?
Yes No
(If they take any ongoing medications, or receive regular treatment, the answer is yes)
--------------------------------------------------->

If Yes, please detail the condition. (i.e. diagnosis, treatment including medications, any possible restrictive activities):

Medications
List any medications, both over the counter and prescribed, accompanying the camper and condition for which they are prescribed. All medications must be in original packaging with dosage instructions
and clearly labelled with camper’s name.

These medications will be kept by the Designated Camp First Aid Person during camp.

Date of Last Tetanus shot:

Any immunizations Not done:

Camper has had H1N1 vaccine or already had the H1N1 flu.

I give permission to give permission to the Designated Camp First Aid Person to release pre-prescribed medication and non-prescribed medication such as:

Cough Drops
Sudafed, Benadryl or Equivalent
Anti-Diarrhea
Motrin
Advil

I do not give permission to give permission to the Designated Camp First Aid Person to release pre-prescribed medication and non-prescribed medication such as:

Cough Drops
Sudafed, Benadryl or Equivalent
Anti-Diarrhea
Motrin
Advil

I hereby authorize the Ross Creek Centre for the Arts staff to secure such medical advice and services, including transportation, as may be deemed necessary for the health and safety of my child/ward. I agree to accept financial responsibility in excess of the benefits allowed by Provincial Health Insurance Plans.

Name:

Date:

Transportation
I Would like my child to use the Bus Service: Yes No	If YES, what Bus Stop will your child be using?
I will bring my child first day: Yes No	I would like to added to the Carpooling List: Yes No
Name and number of people who have permission to pick up your child from the bus stop or Arts Centre: Name: Phone: Name: Phone: Name: Phone:

Payment Information

We require a $55 non-refundable deposit to secure your Camper's place. Please pay Online or call (902)582-3842 to make other arrangements.

I would like to pay the remainder of my balance by:

I would like to pay in installments:

Yes

We will contact you for full payment arrangements once we receive your application.

Submit your Application.

Come Visit Ross Creek Map and Directions

ROSS CREEK CENTRE FOR THE ARTS

Box 190, 555 Ross Creek Rd Canning, Nova Scotia
Canada B0P 1H0
Phone: 902.582.3842
Fax: 902.582.7943
mail@artscentre.ca


Box 190 . 555 Ross Creek Road Canning . NS . B0P 1H0 telephone: 902.582.3842 . facsimile: 902.582-7943