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
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:
Date of Birth (dd/mm/yyyy): Gender:
Address: Postal Code: City:
Emergency Contact Information Emergency Contact:
Home Phone: Cell Phone: Work Phone: Alternate Contact:
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?
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
If yes, is this support:
□ Full time
□ 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
Eating lunch/snacks □ Yes OR
Going to the bathroom □ Yes
Administering any required medications □ Yes
Can your child: Understand basic rules:
Exit/enter a pool unassisted
Does your child require Little Swimmers in the pool? □ Yes
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
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):