2009 - 2010 Intencity P.D. Days Rock Program Registration Form

Please indicate only one session (Please submit separate forms for another child)

Print this form and either mail in with a cheque to address below or Fax with Credit Card
(call in card number if preferred) Alternatively click the Online Store button on the previous menu for Online Secure Credit Card Registration.

Please make cheque payable to East Park Golf Gardens:
Mail to: 1275 Hamilton Rd. London, ON N5W 1B1 Tel: 519-451-2950 Fax: 519-451-5047

If you have any problems or questions you can Email: info@eastparkgolf.com



One Day
2 Days
3 Days
(1) Nov. 6th
(4) Nov. 6th & Dec. 4th
(7) All 3 Days
Nov. 6th, Dec. 4th & April 23rd
(2) Dec. 4th
(5) Nov. 6th & April 23rd
(3) April 23rd
(6) Dec. 4th & April 23rd
 
Child's Name: Sex: Male Female
Date of Birth(DD/MM/YY): Age:
Phone Number: Address:
City: Postal Code:
Release Form:

My child has permission to participate in the East Park Golf Gardens Limited Intencity P.D. Days Rock Program, and I give permission to East Park personnel to render medical aid to my child should it be of a necessity.

Mother's Name: Mother's #:
Father's Name: Father's #:
Emergency Contact Name: Emergency
Phone:
Other Phone#:    
Doctor's Name: Doctor's Phone #:
Health Card #: (Optional)    
Allergies and Medical Conditions:
Other Note:

Early Drop Off/ Late Pickup Nov. 6th
N/A
Early Drop Off $4
Late Pickup $4
Both $6
       
Early Drop Off/ Late Pickup Dec. 4th
N/A
Early Drop Off $4
Late Pickup $4
Both $6
       
Early Drop Off/ Late Pickup April 23th
N/A
Early Drop Off $4
Late Pickup $4
Both $6
       
Please Check One Meal For Your Child
*all meals come with small pop and chips
N/A
Hamburger
Hot Dog
Cheese Pizza
Pepperoni Pizza
PAYMENT POLICY:
A DEPOSIT OF ? IS REQUIRED AT THE TIME OF REGISTRATION IN ORDER TO HOLD A SPOT IN ANY SESSION. BALANCE OF PAYMENT IS DUE BY ?(please include post dated cheque).
CANCELLATION POLICY:
A FULL REFUND WILL BE PROVIDED IF CANCELLATION IS AT LEAST TWO (2) WEEKS PRIOR TO THE REGISTERED SESSION, SUBJECT TO A ? ADMIN CHARGE. IF CANCELLATION IS LESS THAN TWO (2) WEEKS PRIOR TO THE REGISTERED SESSION THEN THE DEPOSIT WILL BE FORFEITED.



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