MAIN CONTACT *

First Name

Last Name

Home / Main Cel Phone *

(###)

###

####

Work Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

SECONDARY / ALTERNATE CONTACT

First Name

Last Name

Home / Main Cel phone

(###)

###

####

Address 1

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

CAMPER INFORMATION *

First Name

Last Name

Age *

10

11

12

13

14

15

Address I if different from MAIN contact

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cel Phone (if applicable)

(###)

###

####

Does she/he have your permission to be released on their own at the end of their camp day? *

yes

no

CODE OF CONDUCT *

CODE OF CONDUCT The safety of each individual in the program is of the utmost importance at Lenwork.Each registrant must recognize a personal responsibility to learn and follow at all times the safety and other rules established by The staff. I hereby agree that any behaviour of the registrant that places him/herself or others at risk may result in the registrant’s immediate dismissal from the program. Further, if dismissed from the program, I agree to cover any expense(s) arising from such dismissal. I hereby acknowledge and agree that no refund will be granted for dismissal or removal of the registrant at his/her request before the end of a program session.

I have read and understand the Code of Conduct

Are there any court orders or custody restrictions which would prevent us from communicating with either parent/guardian?

yes

no

COMPUTER ACCESS

yes there is computer access at home

no, there is no computer access at home

MAC computer?

PC computer?

Ipad?

Other Tablet?

Lenswork reserves the right to cancel any camp program due to insufficient registration. Registrants are contacted by phone or email and offered a choice of: • transferring to another camp • receiving a full refund by cheque, for payments made by cash or cheque • receiving a full refund to Visa or MasterCard *

I have read and understood this

By submitting this registration, I hereby agree that I have read, and fully understand Lenswork's Terms of Service and Codes of Conduct as outlined on this registration form *

I agree

PAYMENT METHOD *

Cash (drop-off or pickup)

Credit Card

Interac Email Money Transfer (*NO H.S.T. charged when paying with this method. You will be emailed with details)

NAME *

First Name

Last Name

GROUP

For which Group is this registration?

GROUP ONE JULY 7-11

GROUP TWO JULY 14-18

GROUP THREE AUG 11-15

GROUP FOUR AUG 18-22