Registration Form

Please Select the Age Group (note, each child needs a registration form) All Campers Must Turned 4 yrs by Start of Camp

4-7 yrs

8+ yrs

Child's Name

Child's Date of Birth

Street Address

City

Postal / Zip code

Street Address Line 2

Region/State/Province

Emergency Contact Name

Emergency Contact Number

Special Notes (i.e Allergies - Please be as specific as possible)

Lollipop has permission to take photos of child for camp purposes, website, and advertisement

Yes

FOR FULL DAY CAMPERS - Lollipop has permission to take child offsite for outdoor excursions in Oakville

Yes

I consent to my child being given medical treatment for any injury while in the care of the registered camp session(s). Lollipop Art Lounge accepts no liability for any injuries suffered during camp.

☎ 905.849.1711

Registration Form