CDJ - Health Form

Please complete a form for each child registered for the camp.

Parent or guardian responsible for the account

Already have an account?

Connect

You will receive a confirmation by email.

First name *

Last name *

Email *

Mobile *

Other parent

Relationship

First name

Last name

Mobile

Child

First name *

Last name *

Gender Please specify

Date of birth *

Health insurance card *

Card number *

Exp. *

Can your child leave alone at the end of the day (4 PM)? *

Yes

Your child will be considered a "walker," and their counselor will let them leave alone at 4 PM, without you or another adult needing to provide the password.

Your child will be sent to the evening childcare service until an adult with the password arrives to pick them up.

x Clear

Password to retrieve the child *

Ex : Dinosaure

Password to retrieve the child

0/3

Restraining order *

Is there a court order declaring that a person has a contact ban with your child?

Yes No x Clear

Restraining order

If there is, please provide us with the first name of that person, their last name, and their relationship to the child (biological parent or other).

Relationship

First name

Last name

Other information

A required field has not been filled.

Please accept all conditions.

Connect to fill this form

Please type in your email or mobile number. We will send you a connection code.

Email or mobile

Connection code

Waitlist

Leave us your coordinates. We will contact you when a spot frees up.

Comment

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Membership

Your membership is tied to your email address. If you are using the wrong email, your membership will not be detected. You can try disconnecting and connecting using another email address.

If you need further assistance, please write to info@activitymessenger.com. Please include a screen capture if possible.