Summer Camp 2022 Form

Ball Till I Fall Canada Inc. Enrolment Form for Summer Camps

Please take the time to fill this form carefully. This information is personal and confidential, and with the exception of certain situations set out in this form, will only be used by Ball Till I Fall Canada Inc. staff to ensure that proper care and attention is given to the health and care of the participant. Location of Program: Canterbury; Jim Tubman Chevrolet Sens Rink Program: Youth Summer Camp 2022
Conditions of Enrolment
1. An Enrolment Form must be completed for each participant. If a participant suffers from severe allergies, parents or legal guardian must complete the Medication Administration Request Form, provide two auto-injectors of epinephrine (i.e. EpiPen) and a current photo of the participant.
2. Parents or legal guardians must notify Ball Till I Fall Canada Inc. staff of any changes to the information given on the Enrolment Form including medical, physical and emotional health issues and/or custody arrangements.
3. Parents or legal guardians must notify Ball Till I Fall Canada Inc. staff if the participant will be late attending the program or absent.
4. Those authorized on the Enrolment Form to pick up the participant will be requested to follow the program’s sign out procedures. Ball Till I Fall Canada Inc. staff will not release a participant to any person who is not authorized by the parent or legal guardian to do so. Participants walking to and from the program site will have their arrival and departure information recorded by Ball Till I Fall Canada Inc. staff.
5. Participants must be picked up and dropped off by the agreed upon time and by those persons authorized to do. In cases where the participant is underage and has permission to leave on their own, parents or legal guardians will provide the time the minor should be expected to arrive and the time they are allowed to leave the program.
6. Parents or legal guardians are responsible for the participant before the start of the program and upon arrival when picking up the participant at the end of the program.
7. Ball Till I Fall Canada Inc. attempts to offer an allergen-safe environment. Please do not send the participant with lunches or snacks that may contain nuts, traces of nuts or nut by-products.
8. Participants are responsible for their own belongings. Ball Till I Fall Canada Inc. shall not be responsible for loss or damage to property belonging to program participants.
  Participants are not to bring electronic devices, iPods, smart phones, tablets, toys or similar items unless requested to do so by Ball Till I Fall Canada Inc. staff.
9. All electronic equipment with photographic capabilities (including cellular telephones) is strictly prohibited.
10. Participants are to be capable of utilizing the washroom facilities with little to no prompting. Participants must be toilet trained prior to the start of the program.
11. Participants with behavioural difficulties may require additional support and may be referred to Inclusive Recreation for specialized and individual program planning.
12. Parents/guardians agree to pay for any and all damages intentionally caused by the participant to facility property and/or the property of others.
13. Illegal drugs, alcohol, or weapons are forbidden.
14. Participants are expected to demonstrate basic respect for the dignity and rights of other program participants and staff. Ball Till I Fall Canada Inc. reserves the right to immediately suspend or terminate the enrolment of any participant who displays any behaviour that violates the following guidelines:
  Inappropriate behaviour, foul language and aggressive behaviour to other participants and staff.
  Respect for Ball Till I Fall Canada Inc. property and the property of others.
15. All participants must comply with Federal, Provincial and Municipal laws and all rules, regulations, policies, procedures and by-laws of Ball Till I Fall Canada Inc.Non-compliance with the Conditions of Enrolment will result in a written warning. If the Conditions of Enrolment continue to be breached, Ball Till I Fall Canada Inc. reserves the right to discharge the participant. A participant may be discharged immediately after a one-time occurrence where the behaviour is deemed serious, i.e. violent and/or abusive.
CONSENT FORM AND PERSONAL PHOTO RELEASE

I authorize Ball Till I Fall Canada inc., its subsidiaries and affiliates, Released Parties, Organizers to collect and use personal information on this form for the purpose of management and administration of the Activities including promoting other events and Ball Till I Fall Canada inc.. I authorize Ball Till I Fall Canada inc to disclose such personal information to third parties, as may be required for this purpose, including to legal and insurance companies. The Organizers may also be required or permitted to disclose such personal information pursuant to relevant privacy laws or other laws.I hereby grant and give perpetually to Ball Till I Fall Canada inc exclusively, the irrevocable right (including, without limitation) all now and hereafter existing civil and/or common law, statutory and moral rights throughout the world and regardless of whether or not such rights are now known, to use my name, address, voice, photograph, image and/or likeness (Attributes) for any and all publicity purposes, commercial or otherwise, in any and all media without compensation or further notification including, without limitation, the perpetual and unlimited right to reproduce (by electrical transcription), tape or other recording process, whether now known or hereafter developed, any materials produced by the Organizers incorporating the Attributes, and the complete and unencumbered right throughout the world, to exhibit, record, reproduce, broadcast, transmit, publish, sell, distribute, perform and use for any purpose, in any manner, by any means and in any medium, whether now known or hereafter developed, all or any part or parts of the matter and things referred to in this paragraph. I acknowledge I will not have or claim to have any right, title or interest in or to any materials produced hereunder incorporating the Attributes.

This agreement supersedes any oral or written statements made by any of the Released Parties and Organizers, or me, in connection with the Activities. This Agreement is governed by the laws of the Province of Ontario where the parties elect domicile in the judicial district of Ball Till I Fall Canada inc namely Owen Sound to the benefit of the Released Parties, as well as their administrators, successors and assigns, and is binding on me and my heirs, successors, assigns, insurers and estate. If any portion of this agreement is held to be invalid or unenforceable, all other provisions shall nevertheless continue to be valid and enforceable.

TERMS AND CONDITIONS OF REGISTRATION

Programs must be paid for in full at the time of registration. Payment can be made by cash, cheque or electronic transfer. Cheques are made payable to Ball Till I Fall Canada Inc.

Waitlist

If a spot should become available due to another person cancelling or transferring out of the class, you will receive a call from staff. At that time you can decide whether to take or decline the spot.

Incorrect age

Unfortunately the registration system will not allow you to register if you do not meet the required age at the start of the program. Contact Ball Till I Fall Canada Inc. for more information.

Cancellations

Courses with insufficient registration will be cancelled. If a class or lesson is cancelled, every attempt will be made to re-schedule. If the class or lesson cannot be rescheduled, a refund will be issued.

Withdrawals and Refunds

Withdrawals Can Be Made:

In person or via email, up to 7 days before course start date for a credit on your Ball Till I Fall Canada Inc. account.

Refunds:

No refunds.

Returned Cheque

A service fee of $25 will be charged on all cheques returned as Non Sufficient Funds (NSF), Stop Payment or Funds Not Cleared.

Credits on Account

Credits can be left on your account for one year.

Medication Administration

If the participant requires that Ball Till I Fall Canada Inc. staff be responsible for storing, administering or supervising the administration of any medication, the participant or parent/guardian is required to sign a release waiver and submit it to the program coordinator. Contact Ball Till I Fall Canada Inc. for additional information.

Severe Allergies

It is the responsibility of the participant or parent/guardian to identify if there are severe allergies that require an auto-injector. Ball Till I Fall Canada Inc. attempts to ensure the safety and well-being of all participants with "allergen-safe zones and practices". Participants or parents/guardians are required to provide two auto-injectors and sign a release waiver to be submitted to the program coordinator.
Participant's Information

Please fill out all details.
Participants Name *

First Name Middle Name Last Name
Date of Birth *

Day Month Year
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Last School Grade Completed *
For Applicable Activities: Can the participant swim in deep water (water over their head) without assistance and without the use of a life jacket for 25 meters ? Swim test may be required. *

yes no
Last Swimming level achieved (If known)
Age *
Will be verified on first day. Please bring ID.
Gender *

Male Female
Phone Number *

Area Code Phone Number
Parent(s)/Guardian(s)/Agency Information

Please fill out all details accurately.
Full name of parent/guardian: *

First Name Middle Name Last Name
Relationship to participant: *
Phone Number *

Area Code Phone Number
Secondary Phone Number (If Applicable)

Area Code Phone Number
Email Address *
example@example.com
Second Parent/guardian

If applicable*
Full name of parent/guardian:

First Name Middle Name Last Name
Relationship to participant:
Phone Number

Area Code Phone Number
Secondary Phone Number (If Applicable)

Area Code Phone Number
Email Address
example@example.com
Emergency Contact

Other than Parents above.
Full name of emergency contact: *

First Name Middle Name Last Name
Relationship to participant: *
Phone Number *

Area Code Phone Number
Secondary Phone Number (If Applicable)

Area Code Phone Number
Email Address *
example@example.com
Which weeks would you like to sign up for? (Please choose all that apply)

Type option 1 Type option 2 Type option 3 Type option 4
Which camp week would you like to sign up for? (you can sign up for one, two.. even all!) *

WEEK 1: July 4 - July 8 ($125) WEEK 2: July 11 - July 15 ($125) WEEK 3: July 18 - July 22 ($125) WEEK 4: July 25 - July 29 ($125) WEEK 5: August 1-August 5 ($125) WEEK 6: August 8-August 12 ($125) WEEK 7: August 15 - August 19 ($125) WEEK 8: August 22 - August 26 ($125) *Extra Week: August 29 - Sept 2 ($275)
Authorized Program Arrival and Departure

Note: Supervision will not be provided outside of designated registered program times. Participants are to arrive and depart solely during the times of the registered program as outlined in the registration confirmation.
Camp Week Selection

PRICE PER WEEK: $125.00 (There are no discounts for multiple weeks, or multiple sibilings. Price is fixed at cheapest rate possible. Thank you.)*Last week is an extra week when camps are not usually provided, as such it is provided at a premium rate.
Arrival - The participant will: *

Get dropped off Arrive on their own (BIKE) Arrive on their own (WALK) Arrive on their own (BUS) Other
Departure - The participant will: *

Get picked up Leave on their own (BIKE) Leave on their own (WALK) Leave on their own (BUS) Other
Authorized Participant Pick-Up

The person picking up the participant may be asked to show picture I.D. daily. Persons not listed below will not be permitted to pick up the participant. Your child's safety is our priority. Absolutely no exceptions.
List the full name of people(s) who are permitted to pick up the participant. *
If there are any access or custody restrictions, please provide legal documentation to Ball Till I Fall Canada staff on first day.
Health/Special Needs Information

If you answer yes to any of the following questions, please fill out this form BEFORE the first day of camp, or your child may be sent home. Form: https://form.jotform.com/221594734500049
Is the participant taking any medication (oral, inhaler, auto-injectors, prescription, non-prescription) ? *

Yes No Other
You answered "yes". Please explain:
Does the participant have any life threating allergies ? *

Yes No Other
You answered "yes". Please explain:
Does the participant have any disease or condition for which they are receiving on-going medical treatment? *

Yes No Other
You answered "yes". Please explain:
Does the participant receive support at school or have accommodations? *

Yes No Other
You answered "yes". Please explain:
Does the participant have a medical condition or disability (physical, mental health or development) that may affect their participation or integration into the program? If yes it is necessary to contact the program coordinator to discuss program and support requirements prior to registration. Please give minimum of at least two week notice before program start date. For more contact information please refer to balltillifalll.ca *

Yes No Other
You answered "yes". Please explain:
Permission to Participate, Assumption of Risk, Waver of Liability and Indemnification Obligation

Please read carefully. By signing this document, you will be assuming risks and and waving certain rights.
By completing e-registration, I and my child understand that my child will be assuming injury and certain legal risks. I, as the Parent or Legal Guardian of the child, confirm that I understand and agree to the conditions contained in this Agreement prior to completing registration.

Permission to Participate
I, as the parents or legal guardian of the participant named above, confirm that this individual is a minor pursuant to the Age of Majority & Accountability Act, and provide permission for them to participate in the camp or activity noted above. I also confirm that I have been provided with the Conditions of Enrolment for this activity, and agree with these conditions.

Assumption of Risks and Waiver of Liability: Covid-19
When participants from multiple families attend a program, there is an increased risk of the COVID-19 virus coming into the facility where we host our programs. Children who are infected with the COVID-19 virus are more likely than adults to have very mild infections or to have no symptoms at all, but these children can still transmit the infection to other children and to adults at the facility. This means that participants can bring home an infection acquired in a facility and put other persons at risk. The screening process will not detect infected children or adults who do not have symptoms at the time of screening. All individuals, including staff, and visitors must be screened daily. For COVID-19 specifically, anyone who fits any of the criteria below will not be allowed into the program. Symptoms outlined below, from the Ministry of Health’s ‘COVID-19 Reference Document for Symptoms’:

1. Fever (temperature of 37.8 degrees C or greater), new or worsening cough, shortness of breath.
2. Other symptoms - sore throat, difficulty swallowing, new olfactory or taste disorder(s), nausea, vomiting, diarrhea, abdominal pain, runny nose, or nasal congestion (in absence of underlying reason for these symptoms such as seasonal allergies, postnasal drip, etc.)
3. Other signs - clinical or radiological evidence of pneumonia
4. Atypical symptoms and signs - unexplained fatigue, malaise, myalgias, delirium (a serious medical condition that involves confusion, changes to memory, and odd behaviours), unexplained or increased number of falls, acute-functional decline, worsening of chronic conditions, chills, headaches, group, conjunctivitis, multi system inflammatory vasculitis in children, unexplained tachycardia (heart rate over 100 beats per minute), including age specific tachycardia for children, decrease in blood pressure, unexplained hypoxia, and lethargy.
5. Symptoms compatible with COVID-19 and in whom laboratory diagnosis of COVID-19 is inconclusive
6. Traveled outside of Canada in the last 14 days

If participants are displaying one or more symptoms of COVID-19, they will not be permitted into the facility or program.

I fully understand that the program or activity for which the participant is partaking in may involve personal risk, dangers, and hazards that all participants are required to assume including but not limited to some risk of illness, or personal injury caused by physical activity or other participants. Understanding this, I hereby accept as participant or on behalf of the minor participant all risks, dangers, and hazards as well as the possibility of illness, personal injury or other loss resulting from the participant’s participation in this program or activity. I agree to release, waive, and discharge Ball Till I Fall Canada Inc., as well as its employees, officials, agents, and volunteers, from all liability to me, and to the participant, and to my heirs, executors and administrators, that we have, or may have in the future, for all loss or damage and from any claims or demands for such loss or damage on account of personal illness, injury, and damage including death or property loss, however caused, as a result of the participant’s participation in this Ball Till I Fall Canada Inc. program or activity.

Indemnification
I hereby agree to indemnify and save harmless Ball Till I Fall Canada Inc. and its employees, officials, agents, and volunteers from any and all liability for any property damage or personal injury to a third party resulting from the participant’s participation in this program or activity.

By signing below, I agree with the terms of the permission to participate, the assumption of risk, the waiver of liability, and the indemnification set out above.
Parent/Guardian Full Name *

First Name Last Name
Date *

Month Day Year
Date
Parent/Guardian Signature *

Clear
Should be Empty:

Ball Till I Fall Canada Inc. Enrolment Form for Summer Camps

Participant's Information

Parent(s)/Guardian(s)/Agency Information

Second Parent/guardian

Emergency Contact

Authorized Program Arrival and Departure

Camp Week Selection

Authorized Participant Pick-Up

Health/Special Needs Information

Permission to Participate, Assumption of Risk, Waver of Liability and Indemnification Obligation