Summer Day Camp 2024
 
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                                           Registration and Waiver Form
Day Camp (including LITs & CITs) - preferred week(s). *
Required
Camper's Name *
Camper's Age on the first day of camp - must be 4 yrs old. If you are 13 - 15 years old we will assume that you are interested in our LIT program *
Camper's Gender *
Parent's Name (s) *
Primary Phone Number *
E-mail Address *
Transportation *
Required
 Anaphylactic Allergies *
Does your child carry an epi-pen or have a serious medical allergy?
Required
Dietary Requirements *
Required
Medical History *
Please describe any relevant information in regards to your child's physical health - or answer n/a for non-applicable.It is very important that you list any typical medical issues that could be confused for COVID-19 symptoms (allergies, coughing, sensitivity to heat. etc)
Emotional, Social and Mental Health History *
Please describe any information that might be helpful regarding anxiety, depression, ADHD, OCD, ASD, Aspergers, OCD and any other relevant information - or answer n/a for non-applicable.
Does your child have 1:1 support at school or require assistance? If so, please contact us to discuss whether our camp is the right fit.  *
Any Other Important Information? *
Is there any additional information about your child that you wish to share. For example: difficult home/school situations, bullying, care of braces/contacts, shyness, home sickness, special procedures that are to be used at the camp. Please be as thorough as you can. It is the parents’/guardians’ responsibility to inform the camp of any emotional, physical, physiological, social or medical challenges faced by the camper that may have an impact upon their camp experience. If you feel that any of these items require further discussion with the camp, please contact the Directors at any time. If you do not have anything to report, please answer n/a for non-applicable
Emergency Contact & Phone Number *
Family Doctors Name & Phone Number *
Do you give us permission to contact the Doctor if necessary? *
Do you give us permission to administer age appropriate over-the-counter medication? *
Health Card #
Is your child's immunization record up to date *
Can your child independently swim without the aid of a flotation device? *
Do you agree to the following Booking Conditions: No refunds for cancellation after June 1st. Before May 1st, full refunds will be issued,  minus an administration fee of $75. Between May 2 - May 31, 75% refund will be issued, minus an administration fee of $75. Changes/deferments to registration will only accepted before June 1. No deferments to other programs or to future dates, beyond the specific program time frame (summer 2024). Administration fee is applied per person, per week. *
I acknowledge that due to health & safety precautions, it is very important that my child is able to follow policies and procedures set out by Great Moose Adventures in the parent handbook. Campers who are unable or unwilling to follow the camp code of conduct may be asked to leave camp to protect the safety of all participants. As always, positive behaviour management will be implemented prior to asking any child to leave camp. *
I acknowledge that if my child falls ill while at camp, they will be placed in a first aid tent under the supervision of a staff person and isolated from the rest of their camp group. Caregivers will be contacted to pick up their camper immediately.  *
I have read the Parent Handbook provide by Great Moose Adventures and understand all of the information provided on the website: (Parent Handbook 2024) *
Please provide information regarding who is allowed to pick-up your child from camp or from the camp transportation shuttle. *
Would you like to subscribe to our e-newsletter for up-coming events and information? *
Required
Do you agree to the Participation Waiver and Medical Consent information listed below? *
Great Moose Adventures reserves the right to suspend clients from activities, programs or performances where their behaviour is deemed unacceptable.Great Moose Adventures cannot be held responsible for the loss, theft or damage of belongings.Great Moose Adventures reserves the right to use photographs/video material of the clients and material created for promotional purposes such as web site, brochures and displays. All films, projects, music, songs, artwork etc. created at Great Moose Adventures may be used by Great Moose Adventures for promotional or educational purposes.By agreeing to these Terms & Conditions the parent or guardian of a child attending a Great Moose Adventures day program fully understands that such a program involves outdoor and indoor physical activities during variable weather conditions and that there are health and safety risks associated with these types of activities.By agreeing to these Terms & Conditions the parent or guardian, their heirs and assigns waive, release and absolve and agree to indemnify and save harmless Great Moose Adventures and their respective directors, officers, employees and agents from all liability arising from attendance and participation in a Great Moose Adventures day program.By agreeing to these Terms & Conditions the parent or guardian affirms that they fully understand the preceding paragraphs and volunteer their child to participate at their own risk.
Payment Information *
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