which week are you registering for?
Week #1: August 11 - 15
Week #2: August 18 - 22
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 voluntarily allow my child(ren) to participate in the summer camp, including its sports program component. I understand that participation in these activities carries inherent risks, including physical and psychological injury and property damage. These risks may arise from the use of equipment and machinery, interactions with other participants, and customary game practices.
I expressly assume and accept any and all risks, whether known or unknown, minor or serious, that may arise from my child's participation.
I affirm that my child(ren) 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 that my child(ren) sustains an injury due to participation in camp activities, I will not hold the Apostolic Pentecostal Church of Pickering, Camp APC or its volunteers liable for any costs associated with treatment. This includes physical and/or psychological injury or property damage that may occur.
Code of Conduct
Participant Code of Conduct Guidelines:
I will be a good sport in all field and class activities, showing respect to players, coaches, and volunteers.
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 complete the following authorization:
Informed Authorization & Release for EpiPen Administration
Medical Emergencies
Acknowledgement of Understanding
Full Name
Date
Please Be Advised:
Submit Registration Form
