Sunshine Adventures Children Summer Camp Registration Form (2015) Little Engineer

Transcription

1 Sunshine Adventures Children Summer Camp Registration Form (2015) Little Engineer Please use a separate form for each participant. Registrations are processed on a first come first serve basis. Quick Checklist Step 1 -- Completed all sections of the Registration Form Step 2 -- Signed the Parent s Authorization section Step 3 -- Included cheque payment Step 4 -- Mail to or drop off at church (2667 Bur Oak Ave., Markham, ON L6B 1A8) Any health information that changes needs to be communicated to the camp IN WRITING before your child starts A confirmation notice will be to participant following receipt of registration form and fee All necessary camp information will also be to participants prior to the camp Date Received: For Office Use Only Form completed Yes Info. Missing: Camp registered week 1 week 2 week 3 week 4 week 5 week 6 week 7 Amount received: Cash Cheque # Additional discount: Early Bird Regular Sibling discount (name of sibling ) : Before-hour After-hour Other remarks: A. Participant information: Name: Age:

2 Date of Birth: DD MM YY Grade completed (by June 2015): Health Card #: Family doctor & phone #: Does your child have any allergies? If yes, please specify. Does this allergy require an epi-pen? Yes No Does your child take any medication? Yes No If yes, what medication? Please list any medication and dose that your child will be taking to camp. (Please note that all medication must be in its original container and all instructions attached.) Are there any activity restrictions while at camp? Yes No If yes, please specify Is there any special consideration that our staff should know to facilitate a better camping experience for your child? Please specify. B. Family information: Parent / Guardian #1 Name: Phone #: (business or cell) Parent / Guardian #2

3 Name: Phone #: (business or cell) Address: Home Phone # : Emergency contact: Name: Relationship: Phone #: Does your child live with: Both parents Mother only Father only Other (please explain relationship to your child): Is there any security or custody issues we should be aware of in regards to your child? C. Pick up Please list below anyone who is authorized to pick up your child from our camp. Name: Relationship: Phone number: To ensure the safety and security of your child, we follow closely our sign in/out procedure, no exception will be permitted. Parents are required to sign in/out their children in person (i.e. no dropping off by the curb). In addition, only the undersigned parents/guardians and people on the pickup list will be allowed to pick up your child. Attach additional page if more space is needed for your pick up list.

4 D. Camp Information Method of payment: Make cheque payable to Rhenish Church of Canada (no post-dated cheque) More info. Address: 2667 Bur Oak Ave., Markham, ON L6B 1A8 Website: Phone: Please select the week(s) that you would like to register and calculate the require fee: Week 1 July 6-10: Little Engineer (1) Mon Tues Wed Thurs Fri Total Full Time $ 150 (7:30 a.m. 9 a.m.) (4 p.m. 6 p.m.) Sibling discount (10% for 2 nd child) Total camp fee: Week 6 Aug 10-14: Little Engineer (2) Mon Tues Wed Thurs Fri Total Full Time $ 150 (7:30 a.m. 9 a.m.) (4 p.m. 6 p.m.) Sibling discount (10% for 2 nd child) Total camp fee: Final Total: Our Camps are Nut Aware Sunshine Adventures Children Summer Camp is Nut Aware. We ask that you do not send products containing nuts or may contain nuts listed on the labels. Strict guidelines will be followed

5 to ensure all campers are safe. Please remind your children that they are not to share any food with other campers. Children with Allergies and Special Needs Our instructors have standard first aid training. In order to ensure that your child receives appropriate care, we are asking that you let us know of any allergies and/or special needs your child may have. Please indicate them in details in the registration forms. We will contact you to discuss allergies and special needs prior to the start of camp. Please be advised that our staff is not certified in special needs. If children require a one-on-one support worker you will be expected to send a worker with your child. Unacceptable Behavior Policy Sunshine Adventures Children Summer Camp provides a safe and supportive environment to all children. While summer camps are meant to be fun, we do expect all children to follow camp rules, be respectful and friendly to other campers and treat camp facility and all equipment with care. No foul language, intimidation of other students, or abuse of the facility or materials will be tolerated. Campers are on their best behaviour most of the time, however should your child causes unnecessary disruptions during camp, we will call home to notify the parents. Should a child s unacceptable behaviour continue after parent has been notified, our staff from Sunshine Adventures Children Summer Camp reserves the right to remove the participant from the camp for unacceptable behaviour without refund. Camp Cancellation/Program adjustments Sunshine Adventures Children Summer Camp reserves the right to cancel the camp or make minor program adjustments due to unforeseen reasons. Should our camp be cancelled, we will contact you as soon as possible. How did you hear about our summer camp? Previous year participant Mail promotion Friends website Participated in other Kids Love Tech program Others (please specify): E. Parent authorization

6 I hereby give consent for my child to participate in the full program and all activities provided by Sunshine Adventures Children Summer Camp I give permission for the camp organizers to use any photographs, audio recordings or videotapes that my child is in for promotional purposes. To the best of my knowledge, my child is in good health and I will notify the camp if he/she is exposed to any infectious disease. I am aware that participation in recreation and athletic activity involves the risk of personal injury. I release the staff and volunteers of the camp organizers, its directors and staffs from any liability concerning my child s involvement in the programs and activities. The use of the facilities of this camp is made at the risk of the registrant. In case of surgical emergency, I hereby give permission to the physician and medical staff selected by the camp director, to hospitalize, to secure proper treatment for and to order injection, anaesthesia, or surgery for my child, as named on this registration form. Every effort will be made to contact a parent/guardian in the case of emergency. Parent/Guardian Signature: Date: G. Anti-SPAM I give consent to receive electronic messages from Rhenish Church of Canada in regard to news about Sunshine Adventures Children Summer Camps or any information related to their children s ministry. Parent/Guardian Signature: Date: