Childs Name *

First Name

Last Name

How Will You Pay? *

Payments online can be paid through our GIVE tab, simply select "March Break Camp" in the drop down payment when designating payment, as well indicate in the notes area the child's first and last name, as well as MEMO: MARCH BREAK CAMP

Online Via our Website Payment Portal

In-Person (Cash, Cheque, Credit/Debit)

Parent/Guardian Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Phone Number *

(###)

###

####

Secondary Phone Number

Optional

(###)

###

####

Work Phone Number

Optional

(###)

###

####

Best number to contact you with during camp hours *

Primary Phone Number

Secondary Phone Number

Work Phone Number

Best way to communicate? (Receive Updates) *

Click all that apply!

Email

Text

Call

Social Media

Childs Birth Date *

MM

DD

YYYY

First Emergency Contact's Name *

First Name

Last Name

Phone

(###)

###

####

Second Emergency Contact's Name *

First Name

Last Name

Phone

(###)

###

####

Digital Signature *

*By typing your first and last name below, you acknowledge that the information provided is accurate and is being submitted willingly to Willowdalepc's Treehouse Ministry*

First Name

Last Name

Digital Signature *

*By typing your first and last name below, you acknowledge that the information provided is accurate and is being submitted willingly to Willowdalepc's Treehouse Ministry*

First Name

Last Name

Please be advised that any child/children with special needs must be accompanied by their own support worker as our staff is not trained or equipped to care for them. The support worker must be provided by the parent of the child. *

Do you understand and agree with the above statement? (Please choose an option below)

Yes

No

Does your child have a special need that requires a Support Worker // Please consider the following criteria. *

Does your child have special needs that significantly impact their ability to participate independently in camp activities? Does your child require assistance with personal care tasks such as dressing, eating, or using the restroom due to their special needs? Does your child have challenges with communication or understanding instructions that require additional support? Does your child exhibit behavioral challenges related to their special needs that may require specialized attention or intervention? Does your child have medical needs related to their special needs that require regular monitoring or assistance from a trained caregiver? Does your child have mobility limitations due to their special needs that may require assistance navigating camp facilities or participating in activities?

Yes

No

Please provide the name of the support worker.

First Name

Last Name

I am aware that every effort will be made to ensure that my child’s safety throughout their time at Willowdale Treehouse Summer Camps. I agree to allow my child to leave the Willowdale Church Site under supervision of the camp staff in order to participate in the off-site activities. I will not hold Willowdale Pentecostal Church of Willowdale Treehouse Summer camps liable for any accident or misfortune that may occur while my child is attending this camp. *

Do you understand and agree with the above statement? (Please choose an option below)

Yes

No

Digital Signature *

*By typing your first and last name below, you acknowledge that the information provided is accurate and is being submitted willingly to Willowdalepc's Treehouse Ministry*

First Name

Last Name