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Thanks to the support of Syncude, Syncrude Mi Summer Camps
will be provided at a reduced price to the kids in Wood Buffalo this
summer! Kids of all age groups can choose from multi-activity
day camps focused on adventure, expression, excitement and
positive learning through creativity and play.

Please completed the following questionnaire and registration form for your childs registration into our MI Summer Camp

Medical Statement

In case of emergency or illness, every effort will be made to contact the parents or guardians. In the event that contact cannot be made, I agree that in case of emergency or illness, a qualified medical attendant may attend to my child.


 

Policies and Consent

As a condition of participation in this program, the participant does so at his/her own risk and neither the RRC nor its employees will be liable for any loss, damage, or injury whatsoever that may occur during any part of his/her participation. The participant or parent/guardian of the participant agrees to pay for any ambulance services required and authorizes RRC to send participant directly to the hospital by ambulance at their discretion. All participants with a disability, allergy, and/or medical condition which may affect their participation in the program must inform our staff at a time of registration.


 

Photo Release

I hereby grant RRC permission to use my likeness in a photograph in any and all of its publications, marketing materials, and website entries, without payment or any other consideration. I understand and agree that these materials will become the property of RRC and will not be returned. I hereby irrevocably authorize RRC to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing Regional Recreation Corporation of Wood Buffalo’s programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge RRC from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.


 

Sunscreen & Insect Repellent

Participants are responsible for providing their own sunscreen and insect repellent. Please send in original container with your child’s name on it. RRC Staff will assist children with application if required. RRC does not provide sunscreen or insect repellent. A parent’s signature is required in order for staff to apply sunscreen and insect repellent.


 

Pick Up Guide

If a parent/guardian or approved individual for pick-up is going to be late, it is asked that they notify program staff, as soon as possible, by calling 780-793-6900.


COVID 1- 19 Symptom Check 

 Parents are required to complete a proper symptom check each day for their child prior to them coming to the facility. Children who are sick must stay home. The self assessment can be found at

 https://myhealth.alberta.ca/journey/covid-19/Pages/COVID-Self-Assessment.aspx

Please do not send your child to the program if they are experiencing any symptoms of COVID-19, including:

  • Common Symptoms: cough, fever, shortness of breath, runny nose or sore throat
  • Other symptoms including: stuffy nose, painful swallowing, headache, chills, muscle or joint aches, feelings unwell in general, new fatigue, or severe exhaustion, gastrointestinal symptoms (nausea, vomiting, diahrea or unexplained loss of appetite), loss of sense of smell or taste, conjunctivitis (pink eye). 
  • Symptoms of Severe Illness: difficulty breathing or pneumonia

Children that present any of the symptoms listed above will be isolated by trained staff. Parents and Guardians will be contacted immediately and are responsible for picking their child up right away.

We strongly encourage campers and parents to wear masks for drop off and pick up. Campers will not be required to wear masks during activities. 
 


Registration Processes

  • All registration must be completed by 12pm the Friday prior to the week of Camp 
  • There will be no drop in's and children must be registered to attend
  • Children must be picked up by 4:30pm each day


I certify that all of the above information is current and accurate to the best of my knowledge.

November 4, 2024----

First Camper's Name

First Name*

Last Name*

Phone*
First Camper's Date of Birth*
First Camper's Information

Does your child have any allergies? *

Does your child have any medical conditions? If so, please list: *

Does your child require any daily and/or emergency medications? If so, please list (ex. insulin, inhaler, Epi-Pen)
Does your child have any concerns with the following physical based items? Please check all that apply.
Vision
Hearing
Speech
Nutrition
Clumsiness
Sleep

Are there any other physical concerns not listed above?
Does your child have any concerns on the following behavioral based items?
Over Activity
Agression
Shyness
Unhappiness

Are there any other behavorial concerns not listed above?
First Camper's Signature*
Second Camper's Name

First Name*

Last Name*
Second Camper's Date of Birth*
Second Camper's Information

Does your child have any allergies? *

Does your child have any medical conditions? If so, please list: *

Does your child require any daily and/or emergency medications? If so, please list (ex. insulin, inhaler, Epi-Pen)
Does your child have any concerns with the following physical based items? Please check all that apply.
Vision
Hearing
Speech
Nutrition
Clumsiness
Sleep

Are there any other physical concerns not listed above?
Does your child have any concerns on the following behavioral based items?
Over Activity
Agression
Shyness
Unhappiness

Are there any other behavorial concerns not listed above?
Third Camper's Name

First Name*

Last Name*
Third Camper's Date of Birth*
Third Camper's Information

Does your child have any allergies? *

Does your child have any medical conditions? If so, please list: *

Does your child require any daily and/or emergency medications? If so, please list (ex. insulin, inhaler, Epi-Pen)
Does your child have any concerns with the following physical based items? Please check all that apply.
Vision
Hearing
Speech
Nutrition
Clumsiness
Sleep

Are there any other physical concerns not listed above?
Does your child have any concerns on the following behavioral based items?
Over Activity
Agression
Shyness
Unhappiness

Are there any other behavorial concerns not listed above?
Fourth Camper's Name

First Name*

Last Name*
Fourth Camper's Date of Birth*
Fourth Camper's Information

Does your child have any allergies? *

Does your child have any medical conditions? If so, please list: *

Does your child require any daily and/or emergency medications? If so, please list (ex. insulin, inhaler, Epi-Pen)
Does your child have any concerns with the following physical based items? Please check all that apply.
Vision
Hearing
Speech
Nutrition
Clumsiness
Sleep

Are there any other physical concerns not listed above?
Does your child have any concerns on the following behavioral based items?
Over Activity
Agression
Shyness
Unhappiness

Are there any other behavorial concerns not listed above?
Fifth Camper's Name

First Name*

Last Name*
Fifth Camper's Date of Birth*
Fifth Camper's Information

Does your child have any allergies? *

Does your child have any medical conditions? If so, please list: *

Does your child require any daily and/or emergency medications? If so, please list (ex. insulin, inhaler, Epi-Pen)
Does your child have any concerns with the following physical based items? Please check all that apply.
Vision
Hearing
Speech
Nutrition
Clumsiness
Sleep

Are there any other physical concerns not listed above?
Does your child have any concerns on the following behavioral based items?
Over Activity
Agression
Shyness
Unhappiness

Are there any other behavorial concerns not listed above?
Sixth Camper's Name

First Name*

Last Name*
Sixth Camper's Date of Birth*
Sixth Camper's Information

Does your child have any allergies? *

Does your child have any medical conditions? If so, please list: *

Does your child require any daily and/or emergency medications? If so, please list (ex. insulin, inhaler, Epi-Pen)
Does your child have any concerns with the following physical based items? Please check all that apply.
Vision
Hearing
Speech
Nutrition
Clumsiness
Sleep

Are there any other physical concerns not listed above?
Does your child have any concerns on the following behavioral based items?
Over Activity
Agression
Shyness
Unhappiness

Are there any other behavorial concerns not listed above?
Seventh Camper's Name

First Name*

Last Name*
Seventh Camper's Date of Birth*
Seventh Camper's Information

Does your child have any allergies? *

Does your child have any medical conditions? If so, please list: *

Does your child require any daily and/or emergency medications? If so, please list (ex. insulin, inhaler, Epi-Pen)
Does your child have any concerns with the following physical based items? Please check all that apply.
Vision
Hearing
Speech
Nutrition
Clumsiness
Sleep

Are there any other physical concerns not listed above?
Does your child have any concerns on the following behavioral based items?
Over Activity
Agression
Shyness
Unhappiness

Are there any other behavorial concerns not listed above?
Eighth Camper's Name

First Name*

Last Name*
Eighth Camper's Date of Birth*
Eighth Camper's Information

Does your child have any allergies? *

Does your child have any medical conditions? If so, please list: *

Does your child require any daily and/or emergency medications? If so, please list (ex. insulin, inhaler, Epi-Pen)
Does your child have any concerns with the following physical based items? Please check all that apply.
Vision
Hearing
Speech
Nutrition
Clumsiness
Sleep

Are there any other physical concerns not listed above?
Does your child have any concerns on the following behavioral based items?
Over Activity
Agression
Shyness
Unhappiness

Are there any other behavorial concerns not listed above?
Ninth Camper's Name

First Name*

Last Name*
Ninth Camper's Date of Birth*
Ninth Camper's Information

Does your child have any allergies? *

Does your child have any medical conditions? If so, please list: *

Does your child require any daily and/or emergency medications? If so, please list (ex. insulin, inhaler, Epi-Pen)
Does your child have any concerns with the following physical based items? Please check all that apply.
Vision
Hearing
Speech
Nutrition
Clumsiness
Sleep

Are there any other physical concerns not listed above?
Does your child have any concerns on the following behavioral based items?
Over Activity
Agression
Shyness
Unhappiness

Are there any other behavorial concerns not listed above?
Tenth Camper's Name

First Name*

Last Name*
Tenth Camper's Date of Birth*
Tenth Camper's Information

Does your child have any allergies? *

Does your child have any medical conditions? If so, please list: *

Does your child require any daily and/or emergency medications? If so, please list (ex. insulin, inhaler, Epi-Pen)
Does your child have any concerns with the following physical based items? Please check all that apply.
Vision
Hearing
Speech
Nutrition
Clumsiness
Sleep

Are there any other physical concerns not listed above?
Does your child have any concerns on the following behavioral based items?
Over Activity
Agression
Shyness
Unhappiness

Are there any other behavorial concerns not listed above?
Camper'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*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Approved Individuals for Child(rens) Pick Up - Please include full name, relationship & valid phone number.

The following individuals are allowed to pick up my child. Photo ID will be required.
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.


By signing below the parent or court-appointed legal guardian agrees that they are also 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*
Parent or Guardian's Information

Does your child have any allergies? *

Does your child have any medical conditions? If so, please list: *

Does your child require any daily and/or emergency medications? If so, please list (ex. insulin, inhaler, Epi-Pen)
Does your child have any concerns with the following physical based items? Please check all that apply.
Vision
Hearing
Speech
Nutrition
Clumsiness
Sleep

Are there any other physical concerns not listed above?
Does your child have any concerns on the following behavioral based items?
Over Activity
Agression
Shyness
Unhappiness

Are there any other behavorial concerns not listed above?
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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