Child's First Name

Child's Last Name

Child's Preferred Name

Chil's Birthdate

Child's Gender

Male
Female
Non-Binary

Child's BC Health Care Number

Waiver: Parent/Guardian Name

As the parent or guardian of the above-named child (“My Child”), I am aware that attending the Elizabeth Fry Society of Greater Vancouver Blue Sky Day Camp Program (the “Camp”) involves many risks and dangers. I understand that known and unknown risks and dangers associated with My Childs participation in this Camp may result in personal injury, death, property damage or loss. I understand as well that personal injury, death, property damage or loss may be caused or contributed to by the negligence or carelessness of others.

In consideration of the Elizabeth Fry Society of Greater Vancouver allowing My Childs participation in the Camp I agree, on behalf of MY Child, My Child’s next of kin, myself, my heirs, agents, assigns, personal representatives and next of kin, that:

1. I ASSUME, ON BEHALF OF MYSELF AND MY CHILD, WHITHOUT LIMITATION, ALL RISKS AND DANGERS associated with My Childs presence at and participation in the Camp.

2. I ASSUME FULL RESPONSIBILITY for ensuring that My Child understands the rules and safe practices associated with the Camp and any Camp activities, and for My Child’s personal safety.

3. I WAIVE ANY AND ALL CLAIMS ON BEHALF OF MYSELF AND MY CHILD against the Camp, the Elizabeth Fry Society of Greater Vancouver and its directors, officers, employees, agents and representatives (all of whom are collectively referred to elsewhere in this document as the “Camp”) arising from or connected with, directly or indirectly, My Child’s presence at the Camp or participation in any activity associated with the Camp.

4. I RELEASE the Camp, on behalf of myself and My Child, from any and all liability for any loss, damage, injury or expense that I, My Child, or My Child’s next of kin, may suffer or incur, due to any cause whatsoever, by reason of My Child’s presence at the Camp or participation in any Camp activity, INCLUDING NEGLIGENCE ON THE PART OF THE CAMP, OTHER PARTICIPANTS OR ANYONE ELSE.

5. I WILL INDEMNIFY AND HOLD HARMLESS the Camp from any and all liability for loss, damage, injury or expense incurred by myself, My Child, or anyone else in connection with My Child’s presence at the Camp or participation in any Camp activities.

I HAVE READ THIS DOCUMENT THOROUGHLY.

I UNDERSTAND THAT, BY SIGNING THIS DOCUMENT, I GIVE UP IMPORTANT LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE ON MY CHILD’S BEHALF OR IN MY PERSONAL CAPACITY.

I UNDERSTAND THAT THE CAMP IS RELYING ON MY FULL RELEASE AND WAIVER OF ALL CLAIMS IN ACCEPTING MY CHILD’S PARTICIPATION IN THE CAMP.

Waiver: Date

Waiver: Signature (Print)

Permission Slip: I (Parent/Guardian Name)

Permission Slip: As the legal guardian of the child (Child's Name)

Permission Slip: Give permission for them to attend the Blue Sky Day Camp in Surrey operated by the Elizabeth Fry Society of Greater Vancouver during session (only one week of camp per child)

Session 1 Juniors (6-11 yrs): July 22nd – 26th
Session 2 Seniors (12-17 yrs): July 29th – August 2nd
Session 3 Juniors (6-11 yrs): August 6th – 9th
Session 4 Seniors (12-17 yrs) : August 12th – 16th

Please check above which session you would like your child to attend

Has the child been affected by their birth family’s involvement in the Criminal Justice System?

Yes
No

Birth family member involved in the Criminal Justice System

If Other, please specify:

Parent/Guardian/Emergency Contact 1: Name

First

Last

Parent/Guardian/Emergency Contact 1: Relationship

Parent/Guardian/Emergency Contact 1: Phone Number

Parent/Guardian/Emergency Contact 1: Email Address

Parent/Guardian/Emergency Contact 2: Name

First

Last

Parent/Guardian/Emergency Contact 2: Relationship

Parent/Guardian/Emergency Contact 2: Phone Number

Parent/Guardian/Emergency Contact 2: Email Address

Child lives with:

If Other, please specify:

Legal Guardianship/Custody:

If Other, please specify:

Home/Mailing Address

City/Town

Province

Postal Code

Cell Number

Email

Alternate Pick-Up Authorization 1: Name

First

Last

In the event that I/We have to pick up my/our child from Summer Camp, they have our permission to leave with the following individual(s)

Alternate Pick-Up Authorization 1: Phone Number

In the event that I/We have to pick up my/our child from Summer Camp, they have our permission to leave with the following individual(s)

Alternate Pick-Up Authorization 2: Name

First

Last

In the event that I/We have to pick up my/our child from Summer Camp, they have our permission to leave with the following individual(s)

Alternate Pick-Up Authorization 2: Phone Number

In the event that I/We have to pick up my/our child from Summer Camp, they have our permission to leave with the following individual(s)

Photo Release

Yes, I give permission to the EFry Summer Camp to include my child in photos taken by camp staff. I understand these photos may be used for promotional purposes (ie. EFry website, reports, brochures etc.) but no names will be used.
No, I do not give permission to the EFry Summer Camp to include my child in photos taken by camp staff.

Dietary Information

Please specify any other dietary information

Allergy Information – please list all the following information: the type and severity of the reaction, whether your child carries an EpiPen, the date of the last reaction, the management and treatment plan, and whether your child can self-administer the EpiPen

Asthma: Does your child suffer from Asthma?

Yes
No

Asthma: If Yes, indicate severity:

Mild
Moderate
Severe

Asthma: What are the triggers for an attack?

Asthma: Does your child carry an inhaler?

Yes
No

Level of Swimming

Dependent/Requires Life Jacket
Semi- independent/Requires Supervision
Independent/Swims Independently

Medications: Is your child currently on any medication (prescribed or homeopathic)?

Yes
No

Medications – Please list all the following: Name of Medication, Prescribing Doctor, Date filled, Expiry Date, and Dosage Directions

Please confirm if the medication will need to be administered at camp

Health History: Please Check (√) if your child has had any of the following:

If your child is currently subject or has previously been subject to any of the above, please give details. Does it affect their ability to participate in activities? If so, how?

Recent Health Concerns: Has the child experienced any recent hospitalizations, operations, serious illnesses/injuries or infectious diseases?

Yes
No

Recent Health Concerns: If Yes, please give date and details

Concerns/Comments: Is there anything else you feel is important that we should know about your child in relation to their participation in the Summer Camp Day Program?

By signing below, I attest to the truthfulness of all information listed on this health form and agree to all the above terms and conditions. I also acknowledge that I will notify the camp if there are any changes to my child’s health, or if he/she is exposed to any communicable diseases.

Parent/Guardian: Signature (Print)

By signing above, I attest to the truthfulness of all information listed on this registration form and agree to all the above terms and conditions.

Parent/Guardian: Date

Registration Form 2024