Spring 2022 - Sunova Centre Program Registration Form

Sunova Centre Program Registration Form - Spring 2022
In-Service Day Camp! - Ages 5-11yrs
8am-5pm

Friday April 22

Friday May 27

Registration Fees:
RM of West St. Paul Resident: $25.00/Camper/Day
Non-Resident: $30.00/Camper/Day
Please select the program(s) you wish to register for: *

In-Service Day Camp - April 22 In-Service Day Camp - May 27

Contact Information
Name *

First Name Last Name
Please list the Names & Ages of the Children attending:
Please only complete this field if you are signing up someone under the age of 18yrs
Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City Province

Postal Code
Age *
Medical Information
Allergies *

Yes No
If you selected YES above please list allergies below:
Medication *

Yes No
If you selected YES above please list medication below:

Emergency Contact Information

*** Please submit contact information for someone we can contact in the case of an Emergency ***
Emergency Contact Name *

First Name Last Name
Emergency Contact Phone Number *
Please enter a valid phone number.
Relationship to Participant *

Sunova Centre Email Distribution List
Would you like the email addresses listed to be added to the Sunova Centre’s Email Distribution List so you can receive updates about all the upcoming Events & Programs happening at the Sunova Centre? *

Yes No Already Receive
Informed Consent Agreement
I/We hereby acknowledge that certain risks of injury are inherent to participation in sports and recreation activities. These types of injuries may be minor or serious and may result from one’s actions, or the actions or in-actions of others, or a combination of both. I/We understand that the Rules & Regulations are designed for the safety and protection of participants and hereby undertake to abide by these Rules & Regulations.

I/We understand that certain activities require a minimum level of fitness and health (physical, mental & emotional) and that each person has a different capacity of participating in these various activities.

I/We agree that the instructors, volunteers or their agents shall not be liable for any injury to any person, the loss or damage to personal property arising from, or in any way resulting from, my or my child’s participation in these activities - unless such an injury, loss or damage is caused solely by the negligence of the above or their agents while acting within the scope of their duties.

I/We hereby release the R.M. of West St. Paul and its agents from any and all liability for any injury sustained by me, regardless of how caused, resulting from my participation. I/We will protect, indemnify and hold harmless the R.M. of West St. Paul and its agents from all claims for damages, including all instances where a Communicable Disease has been transmitted or where (I) or a member of my family have become infected by a Communicable Disease that may arise out of the use of buildings, grounds or equipment.

I/We further agree to indemnify and save harmless the R.M. of West St. Paul and its staff and agents from any and all suits, demands, torts, and actions of any kind which may be brought against its staff or agents for which it / they may become liable by reason of injury, loss, damage or death resulting from, or occasioned to, or suffered by any person or any property, by reason of any act, neglect, or default of mine.
I/We declare that I/We have read and understood the above Informed Consent Agreement in its entirety and hereby consent to participant acknowledging all of the foregoing. *

Agree
Photo Release
I/We agree that any photographs/videos taken by RM of West St. Paul Staff, Instructors or 3rd Party Contractors/Companies may be used in future on-line, social media, print, etc... advertisement or promotion *

Yes No
Payment Options for Sunova Centre Programs

Payments accepted in cash or cheque (made payable to the RM of West St. Paul)

Participants are encouraged to pay on-line when possible or drop-off your payment in the drop-box outside the RM of West St. Paul Municipal Office at 3550 Main St. West St. Paul. Please put payments in an envelope marked with your name and the program you are paying for.

Payment can also be submitted at the first class!

If you bank with a Credit Union an online e-payment can be submitted

How to make an online e-payment:
- Locate the correct vendor in your online banking list
  - Credit Unions: West St Paul, RM – REC
  - Banks: Code for Banks is not set-up so unfortunately payments from Banking Institutions cannot be submitted online
- Enter in your account #
  - Your account number will consist of our identifier # as listed below and your first name
    
    Day Camps: 1000
  - Account Number example: 1000JANE
- Enter in the payment amount and complete your payment!
Credit, Debit & E-Transfers will not be accepted
Should be Empty:

Sunova Centre Program Registration Form - Spring 2022

Contact Information

Medical Information

Emergency Contact Information

Sunova Centre Email Distribution List

Informed Consent Agreement

Photo Release