Step 2 – Summer Camp Registration – Lambton Kingsway Before and After School Program

Summer Camp 2024

(Note: a separate registration form is required for each child)

Child's Name *

Gender *

Male

Female

Child's Date of Birth *

Child's Age on July 1, 2024 *

Which grade will your child be starting in September? *

The first Parent/Legal Guardian added will be designated as primary contact and receive communications.

Parent #1 Name: *

Parent #1 Relationship to Child: *

Mother

Father

Legal Guardian

Parent #1 Address *

Country

City

State

Zip code

Parent #1 Home Phone: *

Parent #1 Cell Phone: *

Parent #1 Business Phone:

Parent #1 Email: *

Parent #1 Permission to pick up. *

Yes

Parent #2 Name: *

Parent #2 Address: *

Country

City

State

Zip code

Parent #2 Home Phone: *

Parent #2 Cell Phone: *

Parent #2 Business Phone:

Parent #2 Permission to pick up. *

Yes

Emergency contacts and additional pickup. (These contacts should live nearby and be able to pick up your child in an emergency situation).

Emergency Contact #1 Name: *

Emergency Contact #1 Phone: *

Emergency Contact #2 Name:

Emergency Contact #2 Phone:

Doctor's Name *

Doctor's Address:

Country

City

State

Zip code

Doctor's Phone: *

Child Profile:

All information is confidential. Failure to disclose medical or behavioural issues may result in removal from the camp.

Does your child require an Epi-pen? *

Yes

(Additional info is required for children with Epi-pens. Please see staff on your child's first day of camp)

Please list any Allergy Information, medication taken, medical or special needs.

Does your child have a history of aggressive behaviour or other behavioural concerns? *

Yes

Photo permission. *

Yes

I grant permission for photos of my child taken by staff of the Lambton-Kingsway Day Camp to appear in the Lambton-Kingsway Day Camp Brochure or other promotional materials regarding the day camp.

Promotional materials. *

Yes

I agree to receive advance registration notice, promotional emails and other materials from Lambton Kingsway Before and After School Program. Information requested is for Lambton Kingsway Before and After School Program marketing purposes only and will not be sold or shared with a third party. Each email provides a one-click method to unsubscribe from the distribution list.

Recreational Swimming *

Yes

Recreational swimming is scheduled during public swim time between 2:15 and 3:15 at the Lambton Kingsway outdoor pool. All children 7 years and under will be required to wear a CSA approved lifejacket unless they pass the facility swim test administered each day by the lifeguards. Campers will be required to supply their own life jackets. Please ensure that the child’s name is on it. I acknowledge that my child may choose to participate in the fun swim at the local outdoor pool. I will provide a CSA approved lifejacket if my child is 7 years of age or under (without which my child will not be permitted to participate in fun swimming). I am solely responsible for ensuring that the life jacket is in good condition and is the correct size for my child.

My child has permission to participate in field trips. *

Confirm

Liability Release Statement: *

I have read and understand all of the information in the brochure and application form. My child is in good physical and emotional health and may participate in all camp activities, except as otherwise indicated in writing on this form. These activities may include, but are not limited to: recreational swimming; field trips; games and activities in the Shale Pit (beside the school grounds); hikes to the nearby park at the Humber River; indoor and outdoor active games.

I recognize that risk of injury or health risk may be involved in these activities, and I hereby assume such risks on behalf of my child. Furthermore, while Lambton-Kingsway Summer Camp will provide reasonable safeguards for the health and welfare of my child, I hereby release and discharge Lambton-Kingsway Before and After School Program Inc., its directors and its employees from all actions, damages, claims and demands whatsoever arising out of participation in this program of the person so named.

In case of emergency, a staff member will contact the parent(s)/guardian(s) of the above named child. If I and my child’s emergency contact(s) are unavailable, I grant official authority to the staff of Lambton-Kingsway Summer Day Camp to act on my behalf including to consent to emergency treatment for my child and to make other decisions necessary for the care, control and protection of my child.

I have read and understood the Liability Release Statement of the Day camp. I certify that the information provided about my child is complete and accurate and any changes to the information will be passed to the Supervisor immediately. I have read and understood the summer camp policies of the Lambton-Kingsway Before and After School Program.

Confirm