GEMS 2017 Summer Camp Sessions
Complete this form to register for GEMS Summer 2017
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Which event would you like to attend?
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First Name of the Child
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Last Name of the Child
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Campers Age (as of June 2017)
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Grade entering in Sept 2017
Parent's Name
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Contact Address
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Phone Number
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Email Address
Your answer
Does your child have any allergies, medical concerns, or food restrictions that we should be aware of?
If yes, please explain under the other option
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Who will be dropping off your child?
Please write the name and relationship to child and a phone number they can be reached at.
Your answer
Who will be picking up your child?
Please write the name and relationship to child and a phone number they can be reached at.
Your answer
Who should we contact in case of an Emergency?
Please write the name and relationship to child and a phone number they can be reached at.
Your answer
Do you give permission to Camp GEMS to use your child's pictures/videos from our sessions on our promotional material and social media pages?
Informed Consent Agreement I/We the undersigned, hereby acknowledge that certain RISKS OF INJURY are inherent to participation in hands-on science and physical fitness activities. These types of injuries may be minor or serious and may result from one’s own actions, or the actions of others, or a combination of both. I/We hereby WARRANT that my/our child is physically fit to participate and understand that the CHOICE to participate brings with it the ASSUMPTION OF THOSE RISKS AND RESULTS which are part of these activities. I/We agree that the paid and voluntary staff at Camp GEMS shall not be liable for any injury to my child or loss or damage to my child’s personal property arising from, or in any way resulting from, her participation in those activities, UNLESS such injury, loss or damage is caused by the SOLE NEGLIGENCE of any of the staff while acting within the scope of their duties. I/We agree to allow my/our child to receive basic first aid/medical care from instructors certified in first aid or trained medical professionals if necessary. I/We declare having read and understood the above INFORMED CONSENT AGREEMENT in its entirety and hereby consent to participate acknowledging all the foregoing. I/We also certify that the information provided in this form is, to my/our knowledge, true and complete. Please note that inappropriate behaviour from any camper will not be tolerated and campers that behave inappropriately may have their camp session terminated as seen necessary by our counseling staff.
Please type your name here. This will be used as an electronic signature.
Your answer
Refund Policy: No refunds after 7 days prior to start of camp session. Cancellation Policy: All cancellations made after 21 days prior to the start of the registered week of camp are subject to a $40 administration fee.
Please initial here to show you understand this.
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How will you be paying the registration fee?
Your registration will not be confirmed unless we receive full payment for the session you have registered your child in.
Tell us how you heard about this event.
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Comments (Optional)
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