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Thank you for choosing Kennedy Road Church Kid's camp this summer. Children must be born between January 1st, 2010 & December 31st, 2015.

5 weeks: July 13th to August 14th, 2020

Days: Monday to Friday (except August 3rd)

Drop off: 8:45-9am

Pick-up: 3:35-4pm

Location:12480 Hutchinson Farm Lane, Caledon, ON

You will be contacted once space is confirmed for payment.

We will be taking every precaution to run a safe and healthy camp, and still pack it with faith, fun and friends!

Fee policy

- Registration forms are to be accompanied with full payment.

Consent, Waiver and Indemnify Release of All Claims

I give permission for my chlid to participate in the activities of Summer Camp 2020. The signature(s) below provides the necessary permission for the participant to participate in the summer camp.

I understand that the completion of a consent form does not guarantee my child's place in camp as spaces are booked on a first come, first served basis.

Further, the undersigned (either the participant or, in the case of a minor, a parent or legal guardian for the participant) agrees to RELEASE and further DISCHARGE, INDEMNIFY, and save harmless Kennedy Road Tabernacle, its membership, employees, and Summer camp volunteers from any and all legal actions, causes of action, claims, and demands for damages, loss or injury, however arising from involvement in the summer camp WHETHER THE RESULT OF BODILY INJURY, ILLNESS, OR DEATH TO THE PERSON, OR LOSS OR DAMAGE TO PERSONAL PROPERTY, which may be sustained by the participant as a consequence of DIRECT or INDIRECT participation in the summer camp including but not limited to summer camp activity.

FAMILY LAW ACT (to be signed by a parent/guardian of minor participant)

The undersigned hereby agrees to INDEMNIFY AND SAVE HARMLESS Kennedy Road Tabernacle within the provisions of PART 5 OF THE FAMILY LAW REFORM ACT (ONTARIO) or any similar or successor legislation thereto from any claims pursuant to the Act by an eligible person identified by the Act.

July 4, 2020

Medical Consent For A Minor (to be signed by a parent/guardian of minor participant)

The undersigned gives permission to take the said participant to a doctor or hospital and authorize medical treatment, including any form of emergency medical, surgical, dental or diagnostic treatment and/or anesthetic for the participant whom a duly qualified medical or dental practitioner may from time to time recommend as necessary or advisable in the participant's interest. The undersigned assumes the responsibility of all medical bills. It is understood the emergency contact (if different from the undersigned) will be contacted if at all possible and that the family physician noted below (if completed) will be contacted if at all posible, but in the event that the noted emergency contact or physician cannot be reached, camp staff may choose a duly qualified physician.

Behaviour Policy

Summer Camp Staff is committed to:

- Ensuring the safety of campers at all times.

- Meeting individual needs without sacrificing the needs of the group.

- Developing a a healthy rapport between campers and leaders.

- Utilizing problem solving skills.

- Providing campers with a summer of laughter and fun.

The Summer Camp Staff will assess behavioural issues individually with concern for the child and the parent. Summer Camp reserves the right to dismiss your child from the program should their behaviour cause harm to themselves, participants, staff or property. There will be no refunds for children sent home due to behavioural issues.

Acknowledgement of Covid-19 guidelines and responsibilities

I am aware my child's temperature will be checked prior to entering camp each day. Should my child be found to have symptoms of Covid-19 as a result of daily screening, they will not be permitted to enter the premise. Should my child be ill or exhibiting any symptoms of Covid-19 prior to arrival at camp, they will be required to stay home and I/we will seek medical attention. If my child(ren) or anyone in the household have travelled outside of Ontario within the last 14 days, they will not be permitted into the camp and should be kept home to self-isolate. If my child(ren) present symptoms of Covid-19 while at camp, he/she will be safely isolated and I/we will be contacted to pick up the child(ren). I have communicated social distancing expectations to my child(ren) to the best of there age appropriate understanding.

Purposes and Extent

Kennedy Road Tabernacle is collecting and retaining this personal information for the purpose of enrolling your child in our summer camp, to assign the student to the appropriate classes, to develop and nurture relationships with you and your child, and to inform you of program updates and upcoming opportunities at our Church. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Kennedy Road Tabernacle to limit the information collected, or to view your child’s information, please contact us.

First Participant/s Name

First Name*

Last Name*

Phone*
First Participant/s Date of Birth*
I certify that I am 18 years of age or older
First Participant/s Information

Childs Health Card Number *
I'd like to register my child(ren) for the following weeks (Check all that apply) Space in each week is not guaranteed as space is limited. *
Week #1: July 13th - 17th
Week #2: July 20th - 24th
Week #3: July 27th - 31st
Week #4: August 3rd - 7th
Week #5: August 10th - August 14th
First Participant/s Signature*
Second Participant/s Name

First Name*

Last Name*

Phone*
Second Participant/s Date of Birth*
Second Participant/s Information

Childs Health Card Number *
I'd like to register my child(ren) for the following weeks (Check all that apply) Space in each week is not guaranteed as space is limited. *
Week #1: July 13th - 17th
Week #2: July 20th - 24th
Week #3: July 27th - 31st
Week #4: August 3rd - 7th
Week #5: August 10th - August 14th
Third Participant/s Name

First Name*

Last Name*

Phone*
Third Participant/s Date of Birth*
Third Participant/s Information

Childs Health Card Number *
I'd like to register my child(ren) for the following weeks (Check all that apply) Space in each week is not guaranteed as space is limited. *
Week #1: July 13th - 17th
Week #2: July 20th - 24th
Week #3: July 27th - 31st
Week #4: August 3rd - 7th
Week #5: August 10th - August 14th
Fourth Participant/s Name

First Name*

Last Name*

Phone*
Fourth Participant/s Date of Birth*
Fourth Participant/s Information

Childs Health Card Number *
I'd like to register my child(ren) for the following weeks (Check all that apply) Space in each week is not guaranteed as space is limited. *
Week #1: July 13th - 17th
Week #2: July 20th - 24th
Week #3: July 27th - 31st
Week #4: August 3rd - 7th
Week #5: August 10th - August 14th
Fifth Participant/s Name

First Name*

Last Name*

Phone*
Fifth Participant/s Date of Birth*
Fifth Participant/s Information

Childs Health Card Number *
I'd like to register my child(ren) for the following weeks (Check all that apply) Space in each week is not guaranteed as space is limited. *
Week #1: July 13th - 17th
Week #2: July 20th - 24th
Week #3: July 27th - 31st
Week #4: August 3rd - 7th
Week #5: August 10th - August 14th
Sixth Participant/s Name

First Name*

Last Name*

Phone*
Sixth Participant/s Date of Birth*
Sixth Participant/s Information

Childs Health Card Number *
I'd like to register my child(ren) for the following weeks (Check all that apply) Space in each week is not guaranteed as space is limited. *
Week #1: July 13th - 17th
Week #2: July 20th - 24th
Week #3: July 27th - 31st
Week #4: August 3rd - 7th
Week #5: August 10th - August 14th
Seventh Participant/s Name

First Name*

Last Name*

Phone*
Seventh Participant/s Date of Birth*
Seventh Participant/s Information

Childs Health Card Number *
I'd like to register my child(ren) for the following weeks (Check all that apply) Space in each week is not guaranteed as space is limited. *
Week #1: July 13th - 17th
Week #2: July 20th - 24th
Week #3: July 27th - 31st
Week #4: August 3rd - 7th
Week #5: August 10th - August 14th
Eighth Participant/s Name

First Name*

Last Name*

Phone*
Eighth Participant/s Date of Birth*
Eighth Participant/s Information

Childs Health Card Number *
I'd like to register my child(ren) for the following weeks (Check all that apply) Space in each week is not guaranteed as space is limited. *
Week #1: July 13th - 17th
Week #2: July 20th - 24th
Week #3: July 27th - 31st
Week #4: August 3rd - 7th
Week #5: August 10th - August 14th
Ninth Participant/s Name

First Name*

Last Name*

Phone*
Ninth Participant/s Date of Birth*
Ninth Participant/s Information

Childs Health Card Number *
I'd like to register my child(ren) for the following weeks (Check all that apply) Space in each week is not guaranteed as space is limited. *
Week #1: July 13th - 17th
Week #2: July 20th - 24th
Week #3: July 27th - 31st
Week #4: August 3rd - 7th
Week #5: August 10th - August 14th
Tenth Participant/s Name

First Name*

Last Name*

Phone*
Tenth Participant/s Date of Birth*
Tenth Participant/s Information

Childs Health Card Number *
I'd like to register my child(ren) for the following weeks (Check all that apply) Space in each week is not guaranteed as space is limited. *
Week #1: July 13th - 17th
Week #2: July 20th - 24th
Week #3: July 27th - 31st
Week #4: August 3rd - 7th
Week #5: August 10th - August 14th
Participant/s Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Second Parent/Guardian Contact

First & Last Name *

Address *

Phone Number *
Can this person pick up the child?*
YES
NO
Photo Consent
Photo Consent *
I authorize the use of my child's photo in online or print format for internal promotional purposes.
I authorize the use of my child's photo in online or print format for external promotional purposes.
I DO NOT authorize the use of my child's photo
Behavioural tendencies/concerns (If applicable)

Please indicate any concerns or behavioural tendencies we should be aware of.
Allergies

Please list any allergies we should be aware of.
Emergency Medication
My child will be bringing medication (prescription only)*
No
Yes (Medicine consent form will be e-mailed)
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Childs Health Card Number *
I'd like to register my child(ren) for the following weeks (Check all that apply) Space in each week is not guaranteed as space is limited. *
Week #1: July 13th - 17th
Week #2: July 20th - 24th
Week #3: July 27th - 31st
Week #4: August 3rd - 7th
Week #5: August 10th - August 14th
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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