March Break Camp Registration

April Break Camp Registration Form

Registration is $75 per child

Child First Name

Child Last Name

Child's Date of Birth

Child Age

Primary Parent Name

Parent Name (Secondary)

Address

Emergency Contact Name

Emergency Contact Name (2)

Child's Grade

Primary Phone Number

Parent Phone Number (Secondary)

Emergency Contact (1) Phone Number

Emergency Contact (2) Phone Number

Non-Parent Pick Up Authorization

Known Allergies

Is the participant on medication?

Yes

If yes, what medication are they taking?

Does the participant require support/accomodations due to a disability?

Yes

If yes, please download Particpant Information Form and upload it here.

Upload Form

I, in my personal capacity and on behalf of the participant, do hereby RELEASE FROM ALL LIABILITY Alison Neighbourhood Community Centre, its Directors, volunteers, employees, agent and representatives (hereinafter Releasee) for any injuries, illnesses or other mishap that may be incurred by the participant while attending a registered or drop in program or event, except where damage or injury is caused by the gross negligence of the Releasee. In the event the participant should be injured or become ill, I authorize any medical treatment that may be required and will assume full financial responsibility for the said treatment

PHOTO RELEASE: I hereby give my permission to Alison Neighbourhood Community Centre and the Cambridge Neighbourhood Organizations for the unrestricted right to take, use and publish my photograph, video and likeness in publications, promotional materials, website and any other communication vehicles, including electronic forms, at its discretion

I hereby certify that the information provided is true and to the best of my knowledge.

Your Signature

Today's Date

Thanks for joining us! You will receive a confirmation email within the next 24 hours with further information about the program.

Camp registration is full. New applicants will not be accepted.