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| September 8, 2010, 11:15 am |
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| Sunday Service Videos to available on Youtube soon |
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Details of Vishnu Mandir Summer Camp 2010
2010-07-05 to 2010-07-30
APPLICATION FORMS AVAILABLE AT THE FRONT DESK
OR VISIT OUR WEBSITE @ WWW.VISHNUMANDIR.COM
FOR MORE INFORMATION PLEASE CONTACT:
SHAMA:(905) 415 3574 Email: shamasingh30@hotmail.com
PAM: (416) 459-6169 Email: pamsarawan@sympatico.ca
THE CULTURE CIRCLE COMMUNITY SERVICES INC
(VOICE OF THE VEDAS LAKSHMI SABHA)
8640 Yonge Street, Richmond Hill, ON L4J 1W8
(P) 905 886 1724
SUMMER CAMP 2010
JULY 5th to JULY30th
(Age 5 to 12 years)
8.30 A.M to 5:00 P.M
CHILDS NAME:________________________________ PHONE:( )_________________
ADDRESS: ____________________(CITY)___________ POSTAL CODE:______________
BIRTHDATE: __________________________________ AGE: ________________________
MEDICAL CONCERNS:_________________________ ALLERGIES: ________________
FATHER’S NAME:______________________________ PHONE: ( )_________________
EMPLOYER: __________________________
MOTHER’S NAME:_____________________ PHONE: ( )_________________
EMPLOYER:___________________________ EMAIL: ____________________
FAMILY DOCTOR:_____________________ PHONE: ( )________________
ADDRESS:_____________________________ HEALTH CARD NO:_____________
EMERGENCY CONTACT: ________________________ PHONE: ( )________________
PERSON TO WHOM CHILD MAY BE RELEASED TO:
NAME:_________________________________ PHONE: ( )________________
UNDER NO CIRCUMSTANCES WILL ANY CHILD BE RELEASED TO ANYONE NOT LISTED ON THIS FORM WITHOUT THE WRITTEN AUTHORIZATION FROM THE PARENTS.
AFTER CARE REQUIRED: YES:_____ NO: _______ HOW LONG:______ HOURS:____
P.S. THE COST FOR AFTER CARE IS $5.00 PER CHILD PER 1/2 HOUR
Cost of camp $500. FOR THE MONTH OR $175. for 1 WEEK; $300 for 2 weeks; $400 for 3 weeks ( Hot Lunch & 2 snacks included)
(Outdoor trips will be an extra cost)
PLEASE MAKE CHEQUE PAYABLE TO THE CULTURE CIRCLE COMMUNITY SERVICES INC..
PAYMENT: CASH: $_________ CHEQUE: $_________ RECEIVED BY: _____________________
THERE IS A $25.00 NON-REFUNDABLE ADMINISTRATION FEE FOR ALL WITHDRAWALS AND CANCELLATIONS.
3 PART APPLICATION-PLEASE COMPLETE IN FULLAND RETURN NO LATER THAN JUNE 18thTH\'2010 TO SECURE YOUR SPACE, CHILDREN MUST BE PICKED UP ON TIME UNLESS AFTERCARE IS NEEDED.
THE CULTURE CIRCLE COMMUNITY SERVICES INC.
VOICE OF THE VEDAS LAKSHMI SABHA
SUMMER CAMP 2010
MEDICAL RELEASE
In the event that we cannot be reached at the time of illness or accident, or if the emergency is such that time does not permit such contact. The Culture Circle Community Services Inc. is hereby authorized to contact the physician on the application form. If the named physician cannot be reached, permission is hereby granted for the camp to call a licensed physician of its choice. I also consent to emergency transportation if necessary.
DOCTOR’S NAME:_________________________ PHONE: ( )________________
ADDRESS:______________________________________________________________________
PARENT/GUARDIAN:______________________ DATE:______________________
SUMMER CAMP 2010
THIS IS A RELEASE OF LIABILITY
PLEASE READ IT BEFORE SIGNING
In consideration of being allowed to participate in and attend at the camp facility and program organized by The Culture Circle Community Services Inc., including all related out trips, events and activities, my child and I (the undersigned) acknowledge, appreciate and agree that:
1. The risk of injury from the activities involved in this program is significant, While particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown and assume full responsibility for myself/my child’s participation; and
3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself/my child from participation and bring such to the attention of the nearest Culture Circle Community Services Inc. representative immediately ; and
4. I HEREBY RELEASE AND HOLD HARMLESS THE CULTURE CIRLCE COMMUNITY SERVICES INC., their officers, conveners, officials, agents and/or employees, sponsoring agencies, sponsors, and advertisers (Releasees), WITH RESPECT TO ANY AND ALL INJURY OR DISABILITY, or loss or damage, to person or property.
I AGREE AND UNDERSTAND THAT I HAVE JUST ENTERED INTO A RELEASE AND HOLD HARMLESS AGREEMENT AND FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I MAY HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
_________________________________ ________________________________
Participants name Participants signature
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Parent / Guardian Signature Date
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