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Registration Form

Youth Stars' Saturday Day Camp is preparing for a Spooky and Fun Halloween Party on Saturday, October 30th!  We encourage your child(ren) to come  dressed up in their favourite Halloween costume!

Location: 57 Westpark Blvd., Dollard-des-Ormeaux,
(Inside the Lutheran Church). You may pull up into our parking lot for Drop-off and Pick-up.

Date: Saturday October 30th, OPEN From: 9:30 AM - 5:30 PM

Ages: 5-12
**Register for your FREE YOUTH STARS MEMBERSHIP 
For more info on benefits, see link below:
Membership Registration Link:
Youth Stars Membership
PRICING
3 Hours (9:30 AM - 12:30 PM) = $25
3 Hours (12:00 PM - 3:00 PM) = $25
3 Hours (2:30 PM - 5:30 PM) = $25
8 Hours (9:30 AM - 5:30 PM) = $40

*Registration must be submitted by Friday October 29th at 11:00 AM 

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* 1. Please select the time period you are registering your child for:

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* 2. Child's Name

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* 3. Child's Age

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* 4. Child's Date of Birth?

Date

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* 5. Home Address

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* 6. Apartment number (if applicable)

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* 7. City / Borough

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* 8. Postal Code

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* 9. Name of your child's school?

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* 10. Please list any allergies and/or dietary restrictions or medical / behavioural issues

Parent / Guardian Information
**** Please note, only persons listed as parent/guardian are authorized to pick up child

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* 11. Parent/Guardian 1 Name

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* 12. Parent/Guardian 1 Phone Number

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* 13. Parent/Guardian 1 Email

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* 14. Parent/Guardian 2 Name

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* 15. Parent/Guardian 2 Phone Number

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* 16. Parent/Guardian 2 Email

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* 17. Where did you hear about Youth Stars 2021-2022 programs?

Payment
E-transfers can be sent to: info@youthstars.org
Checks can be mailed to: Youth Stars 57 Westpark Ave, D.D.O, H9A 2J8

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* 18. Name of Emergency Contact (emergency contact is authorized to pick up your child(ren)

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* 19. Emergency Contact's Telephone number

LATE PICK UPS: Please note late fees of $1 per minute will be charged every minute starting 5 minutes past the end of the class.
COVID-19
Youth Stars will follow all health guidelines recommended by Public Health, the Quebec Government, and the CNESST to the best of our ability. By registering, Parent(s)/Guardians will accept that Youth Stars, following all safety protocols, cannot 100% guarantee non-exposure to COVID-19, and will not hold Youth Stars accountable should their child(ren) be exposed or contract the virus. All staff will receive health and safety training. Youth Stars is committed to maintaining a safe environment. Parent(s)/Guardian will assume responsibility in ensuring they do not send their child to attend the program, should they show any symptoms of Covid-19 as outlined by Santé Quebec. Upon registering and signing this form, parent(s) guardians accept any potential risk of their child contracting Covid-19, and understand that should an outbreak occur, Youth Stars may need to close for an undetermined period of time.
ASSUMPTION OF RISK AND INDEMNIFYING RELEASE
The parent/Guardian of the above named child hereby consent that he/she may participate in Youth Stars Fall program. I hereby release and discharge the Youth Stars Foundation, its organizers and its directors and any and all volunteers from any and all future claims or demands for loss, damage or bodily injuries which may result directly or indirectly from participation in the said activity.
PHOTO AND VIDEO CONSENT
Youth Stars Foundation reserves the right to photograph and videotape my child’s classes and/or activities, for strictly promotional purposes.
Cancellation Fees
YSF reserves the right to cancel the Program for which there is insufficient registration or due to unforeseen circumstances; in such a case, a full refund will be given.
There will be a 50% cancellation fee per child, for any emergency cancellation.No refund will be given after the first day of the Fall program. There will be a fee of $30.00 for any check returned by the bank.

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* 20. Please enter your name

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* 21. By entering my name electronically, I have fully read and agreed to all the terms in this document

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* 22. Please add the date on which you have filled out this form:

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