Camp Chazak Application Form Camper's InformationChild's Name* First Last Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code AgeCurrent Grade*Pre-1AGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Father's Name* First Last Mother's Name* First Last Home PhoneBusiness PhoneFather Cell*Mother Cell*Pediatrician* PhoneEmail Address* Important Medical InformationApplication InformationDates: Tuesday, June 28 - Wednesday, July 20 Ages: Pre1A - Grade 7 Time: Pre1A - Grade 4: Mon-Thurs: 12:30pm-4:00pm, Friday 12:30pm-2:00pm Grades 5-8: Mon-Thurs: 12:30pm-4:15pm, Friday 12:30pm-2:15pm Price: $365 for the full session ($100 per week) + $20 Security fee = $385 (Each additional child = $365) After June 17: $390 ($110 per week) + $20 Security fee - $410 (Each additional child = $390)Choice of Payment* Cash Cheque CHEQUES MUST BE MADE OUT TO CASH OR THE TORONTO CHEDER