REGISTRATION

Camper's Name *

First Name

Last Name

Birth Date *

MM

DD

YYYY

Name *

First Name

Last Name

Name

First Name

Last Name

Home Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Contact Phone *

(###)

###

####

Emergency Contact Phone *

(###)

###

####

Weeks Attending *

Week 1: Tuesday, July 1st to Friday, July 4th

Week 2: Monday, July 7th to Friday, July 11th

Week 3: Monday, July 14th to Friday, July 18th

Week 4: Monday, July 21nd to Friday, July 25th

Week 5: Monday, July 28th to Friday, August 1st

Week 6: Monday, August 4th to Friday August 8th

AWARENESS & ASSUMPTION OF RISK *

I am aware that summer day camp involves risks including risk of personal injury and death. Included in these risks are negligence on the part of The Child Experience, its directors, officers, officials and volunteers, other participants and owners of the facilities where the activities occur (referred to in the rest of this agreement as “TCE Canada and other”). I freely accept and fully assume all such risks and the possibility of personal injury.

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT *

In consideration of TCE Canada accepting my application to participate in this activity, I agree (PLEASE CHECK ALL):

To waive any and all claims that I may have in the future against TCE Canada AND OTHERS.

To release the TCE Canada AND OTHERS from any and all liabilities for any personal injury, death, property damage, expense and related loss, including loss of income that I or my next of kin may suffer as a result of my participation in this activity, due to any cause whatsoever, including negligence, breach of contract or breach of any statutory duty of care.

To hold harmless and indemnify TCE Canada AND OTHERS from any and all liabilities for any damage to property of, or personal injury to, any third-party, resulting from my participation in this activity.

That this agreement is binding on, not only myself, but my next of kin, heirs, executors, administrators and assigns.

PERMISSIONS & MEDIA CONSENT *

I give permission to The Child Experience Canada to include my child in photos taken by camp staff, and/or occasional videotapes taken by local media. I understand these photos may be used for promotional purposes (e.g. Slideshow, website photo gallery, brochures, camp fair display, etc.), but no names will l be used. I further understand that if a camper is not behaving appropriately in a safe manner, the camper will be dismissed from continuing in the camp for the rest of the day, and in serious cases, remainder of the week. I understand that registration forms cannot be processed unless signed and accompanied by payment. I give permission to The Child Experience Summer Camp to transport this camper off camp property for the purpose of medical care or to participate in camp programming which involves leaving the camp premises (e.g. Trips to pools or local parks, etc.). There will be no refunds given after the registration has been processed.

I HAVE READ THIS AGREEMENT AND UNDERSTAND IT *

I AM AWARE THAT BY SIGNING THIS DOCUMENT I AM WAIVING CERTAIN RIGHTS WHICH I OR MY NEXT OF KIN, HEIRS, EXECUTORS, ADMINISTRATORS AND THE SIGNEES MAY HAVE AGAINST TCE CANADA AND OTHERS. I ALSO UNDERSTAND AND ACCEPT THE NO REFUND POLICY.