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TAY TOWNSHIP PROGRAM REGISTRATION FORM - SUMMER 2010
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Pre-registration prior to the start of the program is required as space is limited;
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so register early to avoid disappointment. Tay Township reserves the right to cancel programs due to insufficient registration.
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Register Prior to June 14 and SAVE!
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Select
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Active Living Programs
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Fee
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Fee
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Office Use Only
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Before June 14
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After June 14
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Payment Type
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Receipt #
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No Jumpin' Just Pumpin' TUES or THURS (circle one)
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$ 32.00
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$ 36.00
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SPORT:
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Core Stability Ball - TUES
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$ 32.00
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$ 36.00
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SPORT:
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Yoga TUES or WED (circle one)
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$ 32.00
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$ 36.00
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SPORT:
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Pilates on the Ball
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$ 32.00
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$ 36.00
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SPORT:
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Yoga on the Ball
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$ 32.00
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$ 36.00
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SPORT:
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Zumba
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$ 32.00
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$ 36.00
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SPORT:
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Select
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Youth Programs
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Fee
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Fee
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Office Use Only
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Before June 14
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After June 14
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Payment Type
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Receipt #
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First Aid for Teens - reg'n deadline July 5th
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$ 50.00
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$ 55.00
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SPORT:
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Young Boaters Course - reg'n deadline July 12th
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$ 70.00
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$ 75.00
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SPORT:
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Babysitting Course - reg'n deadline July 26th
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$ 30.00
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$ 35.00
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SPORT:
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Select
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Day Camp Program
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Fee
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Fee
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Office Use Only
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(please circle which week you are reg'n for)
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Before June 14
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After June 14
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Payment Type
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Receipt #
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Week 1 Week 2 Week 3 Week 4
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$ 80.00
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$ 90.00
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CAMP:
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Week 5
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$ 65.00
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$ 75.00
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CAMP:
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Week 6 Week 7 Week 8
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$ 80.00
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$ 90.00
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CAMP:
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Before Care $5 x______ days
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CAMP:
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M T W TH F (circle days) Week(s) #______
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After Care $5 x______ days
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CAMP:
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M T W TH F (circle days) Week(s) #______
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Select
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Youth Camp Program
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Fee
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Fee
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Office Use Only
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√
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(please circle which week you are reg'n for)
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Before June 14
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After June 14
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Payment Type
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Receipt #
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Week 1
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$ 125.00
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$135.00
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TEEN:
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Week 2
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$ 125.00
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$135.00
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TEEN:
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PARTICIPANT INFORMATION - Please Print Clearly
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Last Name First Name
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Age
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Sex M or F
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Home Phone #
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Mailing Address
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Town/City
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Postal Code
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Health Card # & Expiry
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Special Needs/Allergies/Medications
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Emergency Contact during program hours
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I hereby release the Township of Tay from any claims for damages arising from any accident or injury which is caused
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by or arising from the participation of the applicant named above, during any program or in any facility or at any location
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where a program is being held.
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THIS APPLICATION IS NOT ACCEPTED UNLESS SIGNED BY A PARENT/GUARDIAN OR AN ADULT PARTICIPANT.
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Parents Name (please print) If participant is under 18 yrs.
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Signature
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Date
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How did you hear about our program?
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Recreation Guide Website Community Sign Board School Newsletter Word of Mouth Other:__________
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Terms of Registration:
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>Payment can be in the form of cash, debit or cheque (payable to Tay Township).
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>Cheques can be post-dated for 2-weeks prior to the start of the program.
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>Cancellations require 2-weeks notice for refund prior to the start of the program.
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>Please return registration & payment to 450 Park St, Box 100, Victoria Harbour, L0K 2A0 or by fax: 534-4493.
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>Payment for registrations sent by fax must be received within 5 days to ensure your space in the program.
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>Registration subsidies may be available for individuals/families. Call 534-7248 ext 235 for details.
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Personal information contained on this form/document/application is collected pursuant to the Municipal Freedom of Information and
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Protection of Privacy legislation and will be used for the purpose for which it was collected.
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