The Village Summer Camp: Registration Form
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A. PERSONAL INFORMATION
Please complete an individual form for each student you would like registered for the Ubuntu Village Corp. summer camp.
Your child must have be in grade 1 and entering grade 2 in September 2023 to participate in the village summer camp.
Parents Full Name *
Email *
Work/Day Phone: *
Emergency Contact Name: (not a parent) *
Work/Day Phone: *
School *
Please select the school your child(ren) attend.
Campers Info.
First Name *
Last Name *
Birth Date *
MM
/
DD
/
YYYY
Address *
Telephone *
Email *
Is your child allowed to go home alone? (option only for children 10 years old and up) *
Who is authorized to pick-up your child? Name:
Relationship :
Work/Day Phone
Does your child have any allergies, food restrictions or medical concerns, which may affect their participation in our program? Yes / No, If you have checked yes, please explain in the space provided below. *
Please explain type of allergies in the space provided below.
Please check the following items that apply:
Do you have any special needs that we should be aware of? *
The Ubuntu Village Corp. Release of Liability and Assumption of Risk
In consideration of my participation in this The Ubuntu Village Corp. program, I hereby waive, release and discharge any and all
claims for damages I may have, or which may hereafter accrue to me, as a result of my participation in this activity.
This release is intended to discharge in advance the instructors, promoters, sponsors, organizers, project managers, of
this activity and any involved public school entity (and their respective agents and employees) including but not limited
to the The Ubuntu Village Corp., their employees, agents and directors, from and against any and all liability, which
may arise out of negligence or carelessness on the parts of the persons or entities mentioned above.

________________________________________________________________                      ____________________________
Print Name of Participant or Parent/Guardian                                                                      Signature/Date
            if Participant is under 18 yrs.                                  


I understand that this The Ubuntu Village Program may be photographed videotaped, and the The Ubuntu Village does have my permission to use the photographs, videotapes, and/or audiotapes for the purpose of promoting
the work and mission of our organization.
I have carefully read this agreement and fully understand its contents. I am aware that this is a release from liability
regarding the parties listed above and assumption of risk by me.

_________________________________________________________________                       ___________________________
Print Name of Participant or Parent/Guardian                                                                     Signature/Date
             if Participant is under 18 yrs.                                                                              
Please type your name on the line above and date then check this box as confirmation of you signature. *
Required
Please submit your payment to The Ubuntu Village Corp. E-Transfer Payment : theubuntuvillage@tuvillage.ca *
Please enter the name of the child attached to payment transfer. If you would like to discuss alternative payment methods please call 416-676-4441 or email: theubuntuvillage@tuvillage.ca
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