Form

Spring Break Camp 2023 Registration Form
Child's Name*

First NameLast Name
Child's Birthday*

MonthDayYear
Date
Child's Age*
Child's Status Number*
Age Group*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does your child require bus service, if yes please choose a stop*

Seymour Mail BoxesEslha7an CentreMission 4-WayNo Bus Service Needed
Does your child have any allergies?*
If your child has any allergies please list them below:
Does your child have any medical or behavioural issues we should know about? *
If your child has any medical or behavioural issues please list them here:
PARENTS/GUARDIANS/SAFE ADULTS AND EMERGENCY CONTACT INFORMATION
Adult #1 Name*

First NameLast Name
Adult #1 Phone Number*
Adult #1 Email*
example@example.com
Adult #2 Name*

First NameLast Name
Adult #2 Phone Number*
Adult #2 Email*
example@example.com
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
SPRING BREAK CAMP RULES AND EXPECTATIONS
1. Follow all Spring Break Camp (SBC) rules and instructions given by leaders/staff/bus drivers.

2. Attendance is required all 5 days. If your child is unable to attend, please inform us no later than the day of by 9:30AM via email, text or over the phone.

3. Stay within leaders sight and with the group at all times. While at CJMC and when out on field trips.

4. Respect others personal space, belongings and bodies (no hitting, kicking, throwing things or anything that causes physical harm to other kids or leaders/staff).

5. Verbal abuse or inappropriate language will not be tolerated (calling someone mean names, sticking up the middle finger at someone, making the L symbol to call someone a "Loser", taunting other children, etc.), towards other children or especially towards our CJMC SBC staff or leaders.

6. No inappropriate behaviour, touching, noises, language, or discussions.

(For example: no sharing bathroom stalls, no kissing, no touching of other childrens or their own genitals, no swearing, no sexual moaning or language, no sexualized dancing (twerking), no hiding in secluded areas away from leaders, etc. These are all things we have personally witnessed at previous CJMC camps and programs).

7. No bullying of any form will be tolerated, whatsoever.

8. No exclusion of other children or leaders.

9. Respect all CJMC and SBC staff, property and equipment.

10. Follow all bus rules and listen to bus drivers and leaders while on the bus. But rules are: No eating or drinking on the bus, no standing on the bus, must stay buckled on the bus until told to unbuckle, no switching seats on the bus, no yelling/swearing/inappropriate language on the bus, no writing inappropriate pictures or wrods on the bus windows.

THREE STRIKE RULE:

We will have a three strike rule in effect. All incidents of broken rules witnessed by leaders and staff will be noted and an email will be sent to the parent/trusted adult. Verbal warnings will be issued initially, and we will help the children work through the issues; but consistant severe issues will result in strikes. Verbal warning, first strike, second strike, then a third strike will result in removal from Spring Break Camp (SBC).

We want to keep every child safe and we want them to have fun at Spring Break Camp. Please talk to your child about the above rules each morning before sending them to us at Spring Break Camp. Please emphasize we are the ones taking care of them and keeping them safe, so it's important they listen to us and stay with us throughout the entire Camp.
I have discussed these rules with my child*

Yes I have
Parent/Guardian/Trusted Adult Consent
Please read:

I hereby give my approval for my child’s participation in any and all activities prepared by Squamish Nation. In exchange for the acceptance of said child’s candidacy by Squamish Nation, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Squamish Nation and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected program sessions.

In case of injury to said child, I hereby waive all claims against Squamish Nation including all leaders, staff, affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all activities. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Parental Consent Agreement*

For photos/videos of my child to be taken, and to be shared or used on social media, including but not limited to Facebook, Facebook Live, Instagram, Instagram Reels, CJMC Promo, etc.For my child to go on field trips off of CJMC propertyFor my child to be given children's medication if needed (Tylenol, Advil, Allergy meds, Gravol)
Parent Confirmation
BY ACKNOWLEDGING AND SIGNING BELOW, I AM AGREEING TO ALL OF THE ABOVE, AND I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THIS ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Type Full Name*
Signature*

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Date
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Spring Break Camp 2023 Registration Form

PARENTS/GUARDIANS/SAFE ADULTS AND EMERGENCY CONTACT INFORMATION

SPRING BREAK CAMP RULES AND EXPECTATIONS

Parent/Guardian/Trusted Adult Consent

Parent Confirmation