Membership Information

To purchase a membership to save 20% off ALL Girls Inc. Programming for one year, please click here

 

If your membership is still active for the year, please select from the "Member" section.

 

If you do not wish to purchase a membership, please continue.

Parent/Guardian Contact Information

*Please fill out one form per child

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*
Child's First Name
Child's Last Name
Child's Birth Date (dd/mm/yyyy)
Current School
Relationship to Child
Alternate/Emergency Contact Name
Alternate/Emergency Contact Phone Number
Second Alternate/Emergency Contact Phone Number
Please list any medical or allergen information you would like us to be aware of.
Media Release: There may be occasions where pictures of your daughter will be taken - these photos will be used for newsletting, videos, brochures, annual reports, radio, television, newspapers and our website*
  • I give permission to have my daughter and/or myself to appear in any Girls Inc. of Durham publications
  • I do NOT give permission to have my daughter and/or myself to appear in any Girls Inc. of Durham publications

I herby grant permission for my child to participate in Girls Inc. of Durham Camp 2019 program. I give my consent for her to participate in field trips and neighbourhood outings arranged by the staff at Girls Inc.of Durham. Parents will be notified in advance of any such trips and may be asked to provide additional support depending on the outing. I understand that my daughter may be transported by vehicle or walking, with adult supervision, in order to arrive at the destination. I understand that my medical coverage is the primary insurer for my child and will not hold Girls Incorporated of Durham responsible in case of an accident or injury*

Program Permission
  • Yes
  • No

As the parent/guardian of the above child, I recognize that too much exposure to UV rays may increase my child’s risk of getting skin cancer someday. Therefore, I give permission for the staff at; Girls Inc. Summer Camp to apply a sunscreen product (provide by the family) that is broad spectrum with SPF 15 or higher to my child. Girls Inc. will make every effort to limit the amount of time spent outside between the daily time of 11 a.m. and 2 p.m. I understand that sunscreen may be applied to exposed skin, including but not limited to the face (except eyelids), tops of ears, nose, bare shoulders, arms and legs.*

Sunscreen Permission
  • Girls Inc. staff may apply sunscreen to my daughter
  • For medical or other reasons, please do NOT apply sunscreen to my daughter
How did you hear about this program?

Whitby Summer Camp Registration

Quantity
Price
Total
Member Week #1: July 1-5
X
$
145.00=
$
0

Member Week #2: July 8-12
X
$
145.00=
$
0

Member Week #4: July 15-19
X
$
145.00=
$
0

Member Week #5: July 29-August 2
X
$
145.00=
$
0

Member Week #6: August 12-16
X
$
145.00=
$
0

Member Week #7: August 19-23
X
$
145.00=
$
0

Member Week #8: August 26-30
X
$
145.00=
$
0

Member Before and After Care

Please enter the number of weeks you will require before and after care.

X
$
45.00=
$
0

Non-Member Week #1: July 1-5
X
$
170.00=
$
0

Non-Member Week #2: July 8-12
X
$
170.00=
$
0

Non-Member Week #3: July 15-19
X
$
170.00=
$
0

Non-Member Week #4: July 22-26
X
$
170.00=
$
0

Non-Member Week #5: July 29-August 2
X
$
170.00=
$
0

Non-Member Week #6: August 12-16
X
$
170.00=
$
0

Non-Member Week #7: August 19-23
X
$
170.00=
$
0

Non-Member Week #8: August 26-30
X
$
170.00=
$
0

Non-Member Before and After Care

Please enter the number of weeks you will require before and after care.

X
$
55.00=
$
0

Final Total:
$
0
Would you like to sign up for the CIT Program? (Summer Camp Counsellors in Training, 13-16yrs)
  • Yes
  • No

Payment Information

Amount*
$
Name on Card*
Card Number*
Additional Comments

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