SUBSCRIPTION TO THE HOSTİN CAMP SUMMER 2008

Name of a parent or a legal tutor: _____________________________________________________________________________

Address

Street and house number: _________________________________________________

City: ___________________________

Province (State):______________________________________________

Postal Code:___________________________

Telephone Numbers

House:___________________ Office:_______________________ Cellular phone : __________________

Fax:________________

E-mail: _______________________

Name of the person to contact in an emergency situation: _______________________________________

Telephone Number: ______________________________

Child’s name

He/She must be 6-15 years old

Gender

F or M

Date of birth

Week 1

July 6 to 12 2008

Week 2

July 13 to 19 2008

Week 3

July 20 to 26 2008

Understands Czech or Slovak

YES/NO

Knows how to swim

YES/NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  Terms and Conditions

1.     All the children cited in this document are in good mental and physical health and are not under any medication. They do not have food allergies and do not react to insect stings. They have no known condition which could restrain them from participation to the camp.

2.   I, as a parent or legal tutor, am responsible for the payment of the subscription fees and for the expenses caused by my children.

3.     My children have the authorization to participate to all activities organized by the Hostın Camp.

4.   I allow the Hostın Camp to provide medical treatment or to seek medical treatment for my children if it deems it necessary.

5.  I certify that all my children will have a valid health insurance with a 100% coverage in Canada for the whole duration of their stay at the camp. I understand that without a proof of this insurance my children will not be admitted to the camp.

6.     If one of my children must be sent home because of illness or indiscipline, I agree to pay all the fees related to this task and understand that the subscription cost is non-refundable.

7.   The Hostın Association may take and use picture of my child for their advertisement material.

8.      I have legal custody of the children listed on this form and have the legal right to sign this document.

PARENT’S OR TUTOR’S SIGNATURE:_______________________________________________

FEES

The cost of a stay at the summer camp is of 275 Canadian Dollars (CAD) for a week, 500 CAD for 2 weeks and 740 CAD for a 3 week stay for the first child of a family. Each additional child from a same family gets a 10% discount on the subscription cost.

Furthermore, a submission of this form before May 1, 2008 gives right to a 5% discount on the total subscription cost. Association Hostın members can get an additional 25$ off the total payment.  Low-income families may contact the Association for individual arrangements.

If you wish your child to participate to the annual outing to the Arbraska tree climbing (http://www.arbraska.com) an additional 32$ is to be enclosed. Please indicate if you wish your child to take part in this activity.

                                                YES                                                       NO

 

 

The parent/tutor is responsible for the child’s transportation to and from the camp.

Each subscription should be handed in with a deposit of at least 100 CAD. In case of a cancellation, fees of 20$ will be deducted from the reimbursed sum. The total of the fees must be paid at least 14 days before the child’s arrival at the summer camp. No reimbursement is possible after June 15, 2008.

Transport to and from the Trudeau airport

 

The fees for transport to and from the Montreal Trudeau airport are of 150 Canadian Dollars for a first child and 50 CAD for all other children traveling in the same airplane. These fees cover the airport taxes and the parking fees. Please indicate if you will require this service:

                                             YES                                                  NO

 

 

Health Insurance

A copy of the children’s health insurance card must be included with the subscription form. The original health insurance card will be required by the camp’s director at the arrival of the children.

Payment

I join a cheque or cash to the amount specified: $__________________ 

Balance: $____________________

Mailing of the form

You can send us the completed form:

1)   by mail : Association Hostın, Inc., 8970 Marie Victorin, Brossard, Québec, J4X 1A3, Canada.

2)         by fax : 450-923-4159

3)         by e-mail : health.vifad@sympatico.ca

All cheques or money must be sent by mail.

For more information: Camp Director : RNDr. Josef Maxant Tel : 450-465-4844; Fax: 450-923-4159; e-mail : health.vifad@sympatico.ca; Secretary : Viera Šebenova Tel (evening) : 514-385-5153; e-mail: vseben@hotmail.com