2022 SUMMER CAMP REGISTRATION FORM
            Diver's Surname: _________________________           Diver's Given Name: _________________________
            Age: _______ Sex: ______      Date of Birth: _____________   Health Card #_________________________
            Address (street, city, postal code): ____________________________________________________________
            Parent's/Guardian's Name: __________________________________________________________________
            Home Phone: _________________________                Cell/Pager: _________________________________
            Business Phone: ______________________               Email Address: ______________________________
            Family Doctor's Name and Phone #: ___________________________________________________________
            Medical Concerns (allergies, medications, etc.): __________________________________________________
            Emergency Contact Info. (name, number and relation): ____________________________________________
              WEEKS:
               (please circle the week you wish to attend)
              Mon - Fri 9:00 am- 3:00 pm                    1.  If class numbers are insufficient, you will be given the option 
              Fee: $300.00                                  of changing classes or refund of fees.
                                                            2. If you wish to cancel your participation, you must do so prior 
                                                            to the first class.  A $20.00 cancellation fee will be charged.
              Extended hours:                               3. In an emergency, if parent or emergency designate cannot be
              3:00pm - 5:00pm ($100:00 extra)               contacted, permission is given to the Etobicoke Diving Club Inc.
                                                            to seek medical assistance and treatment as may be deemed 
              WEEK 1: July   4 - 8                          necessary.
                                                            4. The Etobicoke Diving Club Inc. will attempt to provide every 
              WEEK 2: July 11 - 15                          safeguard to ensure the safety, health, and welfare of each 
                                                            participant.  The Etobicoke Diving Club Inc., all of its members, 
              WEEK 3: July 18 - 22                          directors, coaches, and instructors will be released from any or 
                                                            all losses, damages, expenses, costs, claims, actions, and 
                                                            demands of whatever nature arising from the participation of the
              WEEK 4: July 25 - 29                          persons so named above in any and all programs stated on this
                                                            form.
              WEEK 5: Aug 2 - 5 (4 days)
                                                            Payment due upon registration by cash or cheque payable to : 
              WEEK 6: Aug  8 - 12                           Etobicoke Diving Club
              WEEK 7: Aug 22 - 26
                                                            Signature of Parent/Guardian
              WEEK 8: Aug 29 – Sep.2
             
                                                            ______________________________   Date: _____________
             E-mail this form to: 
              info@etobicokediving.org