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Registration Form


AGES: 5-12

DATE: MARCH 19TH 2022

ACTIVITIES: 
Leprechaun Mask Crafts
Pot of Gold Clay Designing
4-Leaf Clover Cookie Baking & Decorating
Irish Folk Music & Games

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.

TIME: 9:30AM - 12:30PM  OR  1:30PM - 4:30PM
PRICING
3 Hours (9:30 AM - 12:30 PM) = $25
3 Hours (1:30 PM - 4:30 PM) = $25

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* 1. Please select a time slot:

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* 2. Child's Full Name (First name and Family name)

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* 3. Child's date of birth

Date

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* 4. Child's Age

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* 5. Home Address

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* 6. City / Borough:

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* 7. Apartment number (if applicable):

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* 8. Postal Code:

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* 9. Please list any allergies, dietary restrictions,  medical and/or behavioural issues:

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

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* 10. Parent/Guardian 1 Name (First name and Family name)

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* 11. Parent/Guardian 1 Phone Number

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* 12. Parent/Guardian 1 Email

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* 13. Parent/Guardian 2 Name

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* 14. Parent/Guardian 2 Phone Number

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* 15. Parent/Guardian 2 Email

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

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* 17. Emergency Contact's Telephone number

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* 18. Name of child's school

PAYMENT
By E-transfer only to: info@youthstars.org

*Registration & Payment must be submitted no later than the Saturday of the event, by noon.
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
Youth Stars reserves the right to cancel the event 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. Refunds will not be issued after the day of the event.

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* 19. Please enter your name

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

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

Date

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* 22. Where did you hear about the program?

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