which week are you registering for?
Week #1: August 10 - 14
Week #2: August 17 - 21
Both Weeks
Camper Information
Child #1 First Name
Last Name
Age
Child #2 First Name
Last Name
Age
Child #3 First Name
Last Name
Age
Parent/Guardian Information
First Name
Last Name
Street Address
City
Province
Postal Code
Phone Number
Can this number receive text messages?
Email
*(The majority of camp communication will be via email, please provide a monitored email address)
Emergency Contact
First Name
Last Name
Phone Number
Person(s) authorized to pick-up campers(s)
First Name
Last Name
First Name
Last Name
First Name
Last Name
* Only the people listed here, registering parent/guardian and emergency contact, will be able to pick up the camper. Please inform all authorized persons on this list that they will be required to provide Government Issued ID (Drivers License, Government issued Photo Card, Passport…) prior to a child’s release to them.
PLEASE READ CAREFULLY AND ACKNOWLEDGE EACH CLAUSE WITH YOUR INITIALS
Liability Waiver
I am voluntarily allowing my child/children to participate in the summer camp, which includes a sports program component; and understand that participation in the sports program, and the activities associated with contain inherent risks of pain, physical and psychological injury and property damage. These risks may arise from use of equipment and machinery associated with each sport program, interactions with other camp participants, and customary game practices.
I hereby agree to expressly assume and accept any and all risks, whether known or unknown, minor or serious, that may arise out of my child/children participation.
I hereby declare that my child/children is physically sound and suffers from no condition, impairment, disease, infirmity or other illness that would prevent participation in the summer camp and its associated activities.
In the event of my child/children becoming injured due to the natural process of engaging in activities of summer camp25, I will not hold the Apostolic Pentecostal Church or its’ volunteers liable for any costs associated with curing and/or treating my child/children, as a result of any pain, physical and/or psychological injury, or for damage to personal property, that he/she/they may encounter or experience.
Code of Conduct
Participant Code of Conduct Guidelines:
I will be a good sport to players, coaches and volunteers at every field and class activity,
All parents, children, and volunteers must read and acknowledge the Code of Conduct before registering for camp. Adherence to these guidelines is required throughout the duration of the camp. Violations may result in actions, including temporary or permanent suspension, as determined by the Director of the Children’s Ministry.
Camp Participation Waiver and Medical Consent
I understand as a parent/guardian of a child who is a participant in Camp that my child will participate in activities
including but not limited to physical activities, group games and learning activities. I acknowledge that the choice
to participate brings with it the assumption of those risks and results that are part of these activities resulting from any cause whatsoever including, but not limited to: missed doses of medication; contracting COVID-19; scrapes, bruises, fractures and other injuries sustained in physical activity indoors and outdoors.
I agree that the Apostolic Pentecostal Church of Pickering, Camp APC, its volunteers, trustees, officers, directors, employees, agents and independent contractors, shall not be liable for any personal injury to my child or any loss/damage to my child’s personal property arising from, or in any way resulting from, my child’s participation in these activities due to any cause whatsoever, including negligence, breach of contract, or breach of any statutory duty of care or other duty of care, including any duty of care owed under any applicable occupier’s liability legislation.
I authorize the Apostolic Pentecostal Church of Pickering, Camp APC, its volunteers to administer first aid to my child and to secure medical care for my child in an emergency as deemed appropriate by the attending physician(s).
I certify that the information provided in this registration form is, to my knowledge, true and complete.
I have read and understood the above waiver and consent and confirm that I am the parent or legal guardian of the child mentioned herein who is a minor.
I confirm that I have the complete custody, care and control of the minor and have the legal authority.
Medical Attestation
Medical Declaration:
I hereby declare that my child(ren) has never suffered from, nor currently suffers from, any of the following (if the answer is yes to any of these, please speak directly to the Camp APC Director):
Epilepsy, fits, or seizures
Ear or sinus conditions
Any medical or physical disability
Severe headaches or migraines
Diabetes requiring insulin or other medication
Heart disease
Hearing difficulties or speech impediments
Communicable diseases
If yes, please provide details:
If yes, please provide details:
If yes, please complete the following authorization:
Informed Authorization & Release for EpiPen Administration
Medical Emergencies
Acknowledgement of Understanding
Full Name
Date
Please Be Advised:
Submit Registration Form
