School Winter Break Camp Registration Form

School Winter Break Camp Registration Form

Student Information

Student’s Name
Student's Name
First
Last
Current Grade
Do you receive a prequalified TRC Subsidy?

TRC subsidy payments are accepted. If your family has a TRC Subsidy and also participates in the ACRA KAP Program, your enrollment fees will automatically be covered. Important: You still need to complete this Winter Camp Registration Form online to reserve your spot.

If you have been approved for a TRC Subsidy but do NOT participate in the ACRA KAP program, please contact your TRC case worker as soon as possible, and ask to issue a Temporary Change of Provider Certificate with ACRA as a “Provider” for the December 26th, 2023 through January 5th, 2024 period. Important: Complete this Winter Camp Registration Form online to reserve your spot in the program.

Choose Your Enrollment Days:

Important: Your student’s space in the Winter Break Camp is not reserved until the payment has been received.  You will be prompted to pay today when you press the SUBMIT button at the end of this form. If you cannot pay today with your submission, you can return to this website and locate the Winter Break Camp Payment link under the Youth Services menu.  Payment is due by December 20th. 

REGULAR DAY: 8am to 4pm – Price shown is PER DAY.
EXTENDED DAY: 7am to 5:30pm – Price shown is PER DAY.
REGULAR DAY: 8am to 4pm – TRC SUBSIDY
EXTENDED DAY: 7am to 5:30pm – TRC SUBSIDY
Total

NOTE: A $25 late fee will be charged for each day that your student is not picked up within 15 minutes of the purchased plan end time:
Regular day late fee begins at 4:15
Extended day late fee begins at 5:45

Parent or Guardian information

Name
Name
First
Last
Address
Address
City
State/Province
Zip/Postal
Would you like to add a second Parent’s or Guardian’s Information?

Additional Parent or Guardian Information

Name
Name
First
Last
Address
Address
City
State/Province
Zip/Postal

Who is allowed to pick up your child from School Winter Camp other than the parents or guardians listed above (must be 18 or older)

Name
Name
First
Last
Name
Name
First
Last
Name
Name
First
Last

Is there anyone excluded from picking up your child?

Exclude Persons from Pickup?

Indicate person(s) excluded from picking up your child from School Winter Camp

Name
Name
First
Last
Add another excluded person?

List the additional person excluded from picking up your child.

Name
Name
First
Last
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