Event registration

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Event registration

Event dates: Ages 6-10: August 19th - 22nd
Ages 11-17: August 27th - 30th
Event Address: Thompson Island
Contact us: (613)575-5020 EXT 3165

Age group: 6-10 years old

Email *

Please indicate your child's first and last name *

Please indicate which age group your child will be attending *

6 - 10 Years Old

11 - 17 Years Old

Please indicate your child's age at the time of registration. *

Please indicate if your child has any allergies and what they are allergic to (If none, please write N/A) *

Please indicate your child's shirt size (IE: YOUTH Large or ADULT Medium) *

Emergency contact #1 (Please write full name, relationship to child and phone number) *

Emergency contact #2 (Please write full name, relationship to child and phone number) *

Emergency contact #3 (Please write full name, relationship to child and phone number)

Emergency contact 4 (Please write full name, relationship to child and phone number)

I understand that the staff of the Akwesasne Child & Family Services will make every effort to ensure my child is safe and supervised at all times. However, I agree that the ACFS staff are not liable for any medical expenses, property damages, lost/stolen items, or injuries that may occur during any ACFS outings. *

Yes

I understand that as a parent, I am responsible for ensuring that my child is dropped off and picked up from the meeting place identified to me, unless other arrangements have been agreed upon. *

Yes

I have a working telephone and can be reached at any/all times in case of an emergency and have provided my contact information to the ACFS. *

Yes

I understand that my child may be photographed/videotaped and give ACFS and/or Mohawk Council of Akwesasne permission to use these photos/videos in any future publications (IE: Newspaper, Social Media networks, etc.) *

I give permission to use photos/videos

I do NOT give permission to use photos/videos

I understand that this program will be running on a 3 strike disciplinary system in which children are given a chance to make behavioral changes. If unacceptable behavior continues, participants may be removed for the remainder of the program. Bullying will not be tolerated. *

Yes

The Akwesasne Child & Family Services understands that the use of electronics is vastly growing among children and youth. However, mobile phones and other electronic devices can be improperly used, lost or damaged and it is important that program activities be conducted in an environment free from unnecessary distractions. I understand that ACFS accepts no responsibility for replacing lost, stolen or damaged electronics. *

Yes

All participants who possess an electronic device must agree to not take any pictures or videos of other participants.

My child understands and has agreed

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