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Lions Summer Camps: Assumption of Risk and Consent


CONSENT AND RELEASE AGREEMENT

I authorize the registered camper to participate in the York Lions Sport Camps activities and hereby release, defend, indemnify and hold harmless York University, its employees, officers, Board of Governors and agents will not be responsible for any accident or loss however caused and agree to release York University from all claims and damages which may arise as a result of such accident or loss.  In signing this consent and release agreement, I hereby acknowledge that I have read and understood the conditions and certify that my child is in good physical health.

Personal information in connection with this form is collected under the authority of The York University Act, 1965 and will be used for the purpose of administering your participation in the Activity/Event and related purposes.  If you have any questions about the collection, use and disclosure of your personal information by York University, Sport & Recreation, please contact: Sarah Leckie at sleckie@yorku.ca  or 416-736-2100 x22975.

Today's Date: November 1, 2025

Please select who will be participating...
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First Camper's Name
First Name*
Last Name*
Phone*
First Camper's Age Acknowledgment*
First Camper's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Camper's Information

MEDICAL INFORMATION

Does your child have any allergies:*
No
Yes
Does your child have any medical conditions?*
No
Yes
Does your child require any medication?*
No
Yes
Does your child have any special needs/conditions?*
No
Yes

Please provide details:

NOTE: Camp staff are trained to give Epipens in emergency situations. No other medication will be administered by York staff.


First Camper's Signature*
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*
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Authorized Pick Up
Full Name of Authorized Pick Up Person #1 *
Phone Number of Authorized Pick Up Person #1 *
Full Name of Authorized Pick Up Person #2
Phone Number of Authorized Pick Up Person #2
Full Name of Authorized Pick Up Person #3
Phone Number of Authorized Pick Up Person #3
Unauthorized Pick Up
Do you currently have a custody situation that we should be alerted to? We want to make sure if there is a potential situation whereby an unauthorized person may attempt to pick up your child without consent. Please leave field empty if this does not pertain to you.*
No
Yes
Please indicate the name of the person NOT PERMITTED to pick up your child. Please also follow up with Camp Management and provide a photo of the unauthorized person, if possible. ONLY people authorized may pick up your child.
Relationship to the child
Photo/Video Release
Permission is given for the use of any photos or video of my child taken while participating in the York Lions Camps to appear in a future brochure or other future camp advertising.*
No
Yes
Behaviour & Inclusion Support

We have a Behaviour and Inclusion Specialist as part of our Summer Camp team, that will provide support to all campers. Do you feel your child(ren) will require any additional support and/or ongoing one on one attention?


Will your chil(dren) require ongoing support or additional one on one attention?*
No
Yes

Please give us more information if your child(ren) will require additional support during camp.
Swimming
Please select your child's swimming level. Please note, campers that want to swim must pass a swim test, or they will be given a lifejacket. There will be alternate activities for campers who do not wish to swim. *

Please add any notes about swimming here.
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 Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's Information

MEDICAL INFORMATION

Does your child have any allergies:*
No
Yes
Does your child have any medical conditions?*
No
Yes
Does your child require any medication?*
No
Yes
Does your child have any special needs/conditions?*
No
Yes

Please provide details:

NOTE: Camp staff are trained to give Epipens in emergency situations. No other medication will be administered by York staff.


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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