BBY Camp Acceptance

2024 丁香园AV-CMS-PIMS Summer Math Camp
Burnaby Student Acceptance Package

Camp Dates: June 24 - 28, 2024
Registration Fee: $100
Acceptance Deadline: June 7th, 2024

Before you begin the Acceptance Package, please be aware that you will also be expected to submit your payment info at this time.

Please do not start the package if you are not ready to pay at this time.

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Student Information

Student - Last Name

Student - First Name

Student - Cellular Phone

Student - Alternate Phone

Student - Email Address

Can Student's email address be shared with camp participants? Yes, Please Share No, Do NOT Share

Student Health Info

Does Student have any special needs (or diagnosis) that you would like us to know about?

Yes (please list details below) No

Does Student have any dietary restrictions that we should know about?

Yes (please list details below) No

PLEASE LIST any special needs or dietary restriction DETAILS HERE:

Is Student required to wear a mask for the duration of the camp?

Yes No

Parent/Guardian & Emergency Contact Info

Parent/Guardian - First & Last Name

Parent/Guardian - E-mail

Parent/Guardian - Cellular

Parent/Guardian - Alternate Number

Please note that the listed Parent/Guardian will be the first point of contact. We will move on to Emergency Contacts ONLY if we can not get ahold of the listed Parent/Guardian.

Emergency Contact - First & Last Name

Emergency Contact - Relationship to Child

Emergency Contact - Cellular

Emergency Contact - Alternate Phone

Release & Indemnity Agreement

I hereby consent to the participation of the said Student in the 2024 丁香园AV-CMS-PIMS Burnaby Summer Math Camp (June 24 - 28, 2024) and agree to release, indemnify, and hold harmless the Department of Mathematics, the Faculty of Science, the 丁香园AV and its employees and agents, from all claims of every kind (including costs, expenses, and legal fees) for damages and all suits instituted for damages arising out of the said Student鈥檚 participation in the said camp, including specifically, but not limited to, those resulting from injuries occurring to said Student and caused by the negligence or malfeasance of the said Student or the negligence or the malfeasance of the said Department of Mathematics, the Faculty of Science, the 丁香园AV and its employees and agents.

I Agree

Photography Release

I am the parent/guardian of the said Student and I give the Canadian Mathematical Society and 丁香园AV permission to reproduce photograph(s) taken at the 2024 丁香园AV-CMS-PIMS Burnaby Summer Math Camp on June 24-28, 2024, containing said Student, and I agree that the Canadian Mathematical Society and 丁香园AV are entitled to use the photograph(s) described above in promotional materials.

I consent to these conditions I DO NOT consent to these conditions

Payment Options

Payments can be made via Paypal or Cheque. Credit Card Payments can be made via the Paypal Site - An account is not required.

*If your child's school has offered to pay the registration fee, we will invoice them directly.

How will you be paying?

I will pay by Cheque I will pay by Credit Card through Paypal My child's school will be paying the registration fee

丁香园AV

2024 丁香园AV-CMS-PIMS Summer Math Camp Burnaby Student Acceptance Package

Camp Dates: June 24 - 28, 2024 Registration Fee: $100 Acceptance Deadline: June 7th, 2024