Summer Camp Registration Form 2016 Camp Preferences Which Camp Week would you like to register for? ☐ Week 1: Making Waves Teen Camp

August 15 – August 19, 8:45 am Drop-off – 4:00 pm Pick-up North Centennial Pool This camp is for campers ages 11 and up who do not require constant one-on-one assistance. It is a full-day camp that will have activities that are directed to be specific to older campers. Children who register for this camp must be able to spend an entire day at camp. Activities will include swimming, gym time, and other special activities to be organized by the Camp Coordinator. $75 for 5 days of camp. ☐ Week 2 Morning Camp:

August 22 – August 26, 8:30 am Drop-off – 11:45 am Pick-up St. James YMCA This camp is for campers of any age, who may or may not require constant one-on-one assistance. It is a half-day camp that will have activities that are inclusive to campers of all ages. Activities will include swimming, gym time, and other special activities to be organized by the Camp Coordinator. $50 for 5 mornings of camp. ☐ Week 2 Afternoon Camp:

August 22 – August 26, 12:30 pm Drop-off – 3:45 pm Pick-up St. James YMCA This camp is for campers of any age, who may or may not require constant one-on-one assistance. It is a half-day camp that will have activities that are inclusive to campers of all ages. Activities will include swimming, gym time, and other special activities to be organized by the Camp Coordinator. $50 for 5 afternoons of camp.

If you are registering for half-day camp, are you flexible in your preference for morning or afternoon? □ Yes

OR

□ No

Getting to Know Your Child To help your child’s camp experience as successful as possible we have developed some questions to ‘get to know’ your child as best as we can prior to the start of camp. Please fill these out in as much detail as possible, as this information will be given to your child’s instructor during their training. It will help us to make your child’s experience the best it can be.

Basics First Name:

Last Name:

Date of Birth (dd/mm/yyyy): Gender:

Male

Female

Address: Postal Code: City:

Emergency Contact Information Emergency Contact:

Relationship:

Home Phone: Cell Phone: Work Phone: Alternate Contact:

Relationship:

Home Phone: Cell Phone: Work Phone:

Medical Information Please check all that apply: □ Allergies (Please specify): □ Carries epi pen □ Asthma □ Carries Inhaler □ Dietary concerns (Please specify): □ Wears medical bracelet □ Experiences seizures (Please specify which type):

.

□ Will require medication during camp hours (Please specify):

Is there anything else we need to know about your child (medically speaking) before he or she comes to camp?

Special Need(s):

Associated Needs/Conditions:

Goals at Camp What would you like your child to achieve at camp this year?

What is your child looking forward to the most at camp?

Likes/Dislikes What are your child’s favorite activities and games?

What activities does your child dislike or struggle with?

How can we improve your child’s experience with these activities at camp?

Assistance All answers given under this category are to help us appropriately provide assistance to your child at camp, and will not be restrictive to your application. Please provide full information so that we can help your child have a great experience. Does your child have a designated Educational Assistant at school? □ Yes OR

□ No

If yes, is this support:

□ Full time

OR

□ Part time

How can our instructors best adapt to your child’s abilities when participating in a group at camp?

Does your child require one-on-one assistance for any of the following activities: Changing into swimwear □ Yes OR

□ No

Eating lunch/snacks □ Yes OR

□ No

Going to the bathroom □ Yes

OR

□ No

Administering any required medications □ Yes

OR

□ No

Can your child: Understand basic rules:

□ Yes

OR

□ No

Exit/enter a pool unassisted

□ Yes

OR

□ No

Swim unassisted

□ Yes

OR

□ No

Does your child require Little Swimmers in the pool? □ Yes

OR

□ No

Communication Please describe the best ways to communicate with your child (For example symbols, songs, etc.)

Please describe any teaching strategies that have been successful with your child in the past

Behaviour Does your child have any specific triggers that should be avoided? For example, specific phrases, words, sounds or visuals. If so, please list them below:

How well does your child adapt to change? Please explain:

How severe are your child’s most negative responses? (0-10 with 10 being extremely negative) How frequently do these responses occur?

What is the best way to handle these responses?

Other Is there anything else you would like us to know to make your child’s Summer Camp experience the best it can be?

To participate in certain camp events we will be transporting your child off-site. Do we have your permission to do so? □ Yes OR

□NO

Parent/Guardian Name (Print): Parent/Guardian Signature: Does your child require any special considerations in transportation? Please describe.

Photo and Social Media Consent Form – Summer Camp 2016 During our 2016 Summer Camp there will be photos taken by photographers and supervisors (on occasion). These photographs may be used in advertising to promote the program or Making Waves events as well as on various forms of social media (Instagram, Twitter and Facebook). By signing this form, you are agreeing to have your child’s picture taken by Making Waves Winnipeg. Please check the box that applies: ____ I agree to allow Making Waves Winnipeg to use photos of my child for the above reasons. ____ I do not agree to allow Making Waves Winnipeg to use photos of my child for the above reasons.

Parent/Guardian Name (Print):

Parent/Guardian Name (Signature):

Child’s Name (Print):

Thank you for your support and co-operation!

Making Waves Winnipeg Liability Release Form – Summer Camp 2016 Acknowledgement of Risk or Injury Possibility As a participant in the program I recognize the risk and acknowledge that there are certain risks of physical injury, including death, damages, property damage, or loss which my child may sustain as a result of participating in any and all activities connected with such program, or the use of facilities or equipment. Waiver of Claim for Injury Clause I agree to waive and relinquish all claims that my child may have for injuries or damages as a result of participating in the program or using the facilities or equipment against Making Waves Winnipeg and its officers, employees, other volunteers, and affiliates. Release from Liability Clause I do, hereby, release and discharge Making Waves Winnipeg and its officers, employees, volunteers, and affiliates from any and all claims for injuries, including death, damages, property damage, or loss which may have or may in the future accrue to my child in account of participating in or volunteering for Making Waves Winnipeg.

Parent/Guardian Name (Print):

Parent/Guardian Name (Signature):

Child Name (Print):

Summer Camp Registration Form 2016 Camp ...

Date of Birth (dd/mm/yyyy):. Gender: Male. Female. Address: Postal Code: City: Emergency Contact Information. Emergency Contact: Relationship: Home Phone ...

352KB Sizes 0 Downloads 363 Views

Recommend Documents

Vacation Bible Summer Camp Registration Form 2017.pdf ...
Students in high school and above are welcomed as volunteer counsellors (qualifies for volunteer hours). Please. contact [email protected] ...

2015-2016 Summer Irish Dance Camp Registration Form.pdf
2015-2016 Summer Irish Dance Camp Registration Form.pdf. 2015-2016 Summer Irish Dance Camp Registration Form.pdf. Open. Extract. Open with. Sign In.

Softball Summer Camp
High School Camp (CNGL01): This camp is for current high school softball players that do not play travel softball. Camp will consist of two practices a week from ...

2017 Summer Camp RegFormAndProjectReleaseForm_secured.pdf
Page 1 of 1. 2017 Summer Camp RegFormAndProjectReleaseForm_secured.pdf. 2017 Summer Camp RegFormAndProjectReleaseForm_secured.pdf. Open.

SUMMER YOUTH Camp 2016.pdf
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. SUMMER ...

summer camp app2 2016.pdf
Please return all registration. materials quickly to guarantee. enrollment. Page 2 of 2. summer camp app2 2016.pdf. summer camp app2 2016.pdf. Open. Extract.

2016 Summer Camp Flyer
New Hope-Solebury High School. Dates: Week 1. June 20, 2016 thru June 24, 2016. Week 2. July 25, 2016 thru July 29, 2016. 9:00 am – 3:00 pm M – Thur. 9:00 am – 12:00 pm Fri. TYPICAL CAMP DAY. 9:00. Roll Call & Announcements. 9:15. Camp Stretch.

Chalfont Summer Camp 2016.pdf
Page 1 of 1. SUN* MON THUR FRI SAT. CHALFONT SUMMER CAMP ACTIVITY PROGRAMME. TUE WED. *PLEASE NOTE: SUNDAY FREE DAY OR OPTIONAL EXCURSION AVAILABLE. Blenheim Palace. Adventure Park. Classic London. Oxford. Cambridge Colleges Tour &. Fitzwilliam Museu

New Hope Summer Camp 2016 Volunteer Opportunities.pdf ...
Page 2 of 2. New Hope Summer Camp 2016 Volunteer Opportunities.pdf. New Hope Summer Camp 2016 Volunteer Opportunities.pdf. Open. Extract. Open with.

2016 Summer Camp Schedule.pdf
CATHOLIC CENTRAL HIGH SCHOOL. See Summer Schedule. ** REGISTER STUDENTS FOR GRADE ENTERING IN FALL OF 2016 / 2107 **. 2016 SUMMER ...

Summer Camp 2017 Youth and Preschool registration packet.pdf ...
I spy a dinosaur! Do you? Campers will participate in a dinosaur egg hunt, as well as a fossil dig in the. sandbox. They will learn about the importance of ...

2017 Summer Day Camp registration packet.pdf
Seizures □ Other____________________. Page 3 of 4. 2017 Summer Day Camp registration packet.pdf. 2017 Summer Day Camp registration packet.pdf.

Memphis Debate Summer Camp Registration- DUE ... -
Jun 10, 2011 - Memphis Debate Summer Camp. Registration- DUE Friday, June 10, 2011. Please mail or e-mail this registration to Dwight Fryer. 205 N. Claybrook St., Memphis, TN 38104, Room 208 [email protected]. All Students Complete: Name

Summer Camp - USA.pdf
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. Summer Camp ...

Summer Camp Contract.pdf
... guardian of the. below named student and both parent and player agree and understand all terms and policies above as. attested by the following signatures.

Summer camp Portuguese.pdf
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. Summer camp ...

Summer camp English.pdf
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. Summer camp ...

Summer Camp Brochure.pdf
Page 2 of 12. 2. Spani. 0. sh Imme. 1. rsion. 6. Camp. P P 3 - S E C O N D G R A D E. Our philosophy How we achieve our goals What's the next step? Explore ...

Summer Camp - Canada.pdf
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. Summer Camp ...

Summer Camp & Volunteer.pdf
Summer Camp & Volunteer.pdf. Summer Camp & Volunteer.pdf. Open. Extract. Open with. Sign In. Main menu. Displaying Summer Camp & Volunteer.pdf.

Summer Camp - Scotland.pdf
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. Summer Camp ...

Summer Camp - Ireland.pdf
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. Summer Camp ...

Summer camp Spanish.pdf
CONTACTO: Nada Novakovic. [email protected]. Page 1 of 1. Summer camp Spanish.pdf. Summer camp Spanish.pdf. Open. Extract. Open with.

Summer Camp Nanclares.pdf
Page 2 of 6. Cuenta con. Residencia. Comedor. Frontón. Campo de fútbol. Cancha polideportiva. Senda Botánica. Piscina (en la localidad). Con quien.