Winter Camp Registration - CHAOS Summer Camps Ltd.

January 3 Winter Camp Day - Reserve Your Spot Today

Camp Details

Inclusive Early-Drop/Pick-up (7:30am & 4pm)
Soccer, Tag Games, Cottage Games and much more
Experienced teachers as instructors/supervisors
Lunch not included
LIMITED OFFER: First campers to register will receive a CHAOS SUMMER CAMP jersey (while supplies last)

Beckwith Recreation Complex, 1319 9th Line Rd, Beckwith, ON

Camper Information

If registering multiple campers, please resubmit this for for each individual.

Participant First name(Required)

Participant Last name(Required)

Participant Date of Birth(Required)

Gender(Required)

Male

Female

Is there any information that would serve the camp staff well to understand about your participant? If so, please include some details below

Parent/Guardian Information

– Contact information – Address – Emergency contact information

Parent/Guardian First Name(Required)

Parent/Guardian Last Name(Required)

Email(Required)

What is your relationship with the participant?(Required)

Phone Number – Primary(Required)

Phone Number – Secondary

Participant Home Address(Required)

Street Address City Province Postal Code

Emergency Contact Person(Required)

Emergency contact person relation to participant(Required)

Emergency contact person phone number(Required)

In the event of an emergency (i.e., inclement weather, injury) you give permission to contact via text message at:(Required)

Primary phone number

Secondary phone number

Neither primary nor secondary number

Medical Information

To best support your child, please help us understand any medical concerns, if a concern exists.

Are you disclosing any of the participant's specific medical conditions or allergies?(Required)

If any medical conditions were disclosed above, please use the space below to communicate the information specific to the concern.

Others (please specify)(Required)

Consent and Waivers

Winter Day Camp – HST included in price

Based on your child’s age are a few options for camp registration. Please select the option below that best suits.

If you select a “Pay Manually” option, cash/e-transfer can be made the day of in the event that a player wants to return for another day beyond the initial selection made on this form.

Mini Masters (U5/U6) – Born 2019/2020

N/A

Mini Masters options(Required)

Please contact to learn more. (play@chaosacademy.ca / 613-617-6363)

Tag Masters (U7/U8) – Born 2017/2018

N/A

Tag Masters option(Required)

Boys [limited space] – Jan 3 Winter Day Camp (HST incl.)

Girls [open] – Jan 3 Winter Day Camp (HST incl.)

Skill Academy (U9/10/11) – Born 2014, 2015, 2016

N/A

Skill Academy option

Boys [limited space] Jan 3 Winter Day Camp (HST incl.)

Girls [open] Jan 3 Winter Day Camp (HST incl.)

Junior CHAOS (U12/U13) – Born 2012/2013

N/A

Junior Academy option(Required)

Boys [open] Jan 3 Winter Day Camp (HST incl.)

Girls [open] Jan 3 Winter Day Camp (HST incl.)

Checkout

Total

How would you like to pay?

Pay Online

Pay Manually (eTransfer)

Cash ($45)

Credit Card

Send email transfer to play@chaosacademy.ca and please include the name of the attendee in the notes

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