2024 March Break Camp Registration Form

March Break Camp Registration

Therapeutic Horse Camp
General Family Information
Registering Parent

First NameLast Name
Referred by
How many campers are you registering?

1234If you are registering more than four (4) campers, please fill out the first four on this form and then contact us at office@horsetherapycanada.com, to register the other campers.
Is there a divorce / separation?

YesNo
Camper Lives with

Parent / Guardian 1Parent / Guardian 2Both
Information should be sent to:

Parent / Guardian 1Parent / Guardian 2Both
Are there any restrictions on either parent's access/custody?

NoYes
Custody/Access Details:
Upload legal documentation

Browse Files

Cancelof
Parent / Guardian # 1 Information
Relationship to camper(s)*
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Home Phone*

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Work Number

Area CodePhone Number
Extension
Occupation*
Place of Work*
Parent / Guardian # 2 Information

If applicable
No additional parent / guardian is present
Relationship to camper(s)
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Work Number

Area CodePhone Number
Extension
Occupation
Place of Work
Emergency Contact # 1

If parents cannot be reached
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship to camper(s):*
Emergency Contact # 2

If parents cannot be reached
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship to camper(s):*
Camper # 1 Information
T-shirt Size*

XS - 4-5 yearsS – 6-7 yearsM – 8-9 yearsL – 10-11 yearsXL – 12-13 yearsAdult SAdult MAdult LAdult XLAdult 2XL
First Name*
Last Name*
Preferred Name
Date Of Birth*

MonthDayYear
Date
Gender*

MaleFemaleNon-binary / Non-conformingTransgenderPrefer not to respond
If Transgender, which gender does your child identify with?
Grade entering in the fall*
School Attending*
Has this camper ever attended camp before? When? Where? Any details we should know about (i.e. bullying, favourite camp activities, etc.)*
Name of friends that this camper would want to be grouped with, if any.
Any medical problems, dietary restrictions that camp staff should be aware of? (Example: epilepsy, diabetes, ADHD/ADD, allergies, food intolerance, drug reactions, medications, etc.)*
Does this camper have a life threatening allergy, or is an epi-pen required?*

YesNo
Dietary restrictions*

KosherVeggieHalalNo
General Behaviour: Is there anything that we should know about this camper's personality, behaviour, emotional development? Does the camper have any difficulties, fears, or anxieties?*
Does this camper have any special needs or any behaviour challenges that we should know about? If so, please explain*
Does this camper need extra supports?*

NoYes, 1:1Yes, 2:1
1:1 and 2:1 supports are professional, adult staff. We suggest that you consider a 1:1 or 2:1 support for your camper if they have any specialty circumstances (toileting help needed, aggressive behaviours, ASD levels 2 or 3, run away from groups, etc.)
Camper # 2 Information

If applicable
T-shirt Size

XS - 4-5 yearsS – 6-7 yearsM – 8-9 yearsL – 10-11 yearsXL – 12-13 yearsAdult SAdult MAdult LAdult XLAdult 2XL
First Name
Last Name
Preferred Name
Date Of Birth

MonthDayYear
Date
Gender

MaleFemaleNon-binary / Non-conformingTransgenderPrefer not to respond
If Transgender, which gender does your child identify with?
Grade entering in the fall
School Attending
Has this camper ever attended camp before? When? Where?
Name of friends that this camper would want to be grouped with, if any.
Any medical problems, dietary restrictions that camp staff should be aware of? (Example: epilepsy, diabetes, ADHD/ADD, allergies, food intolerance, drug reactions, medications, etc.)
Does this camper have a life threatening allergy, or is an epi-pen required?

YesNo
Dietary restrictions

KosherVeggieHalal
General Behaviour: Is there anything that we should know about this camper's personality, behaviour, emotional development? Does the camper have any difficulties, fears, or anxieties?
Does this camper have any special needs or any behaviour challenges that we should know about? If so, please explain
Does this camper need extra supports?

NoYes, 1:1Yes, 2:1
1:1 and 2:1 supports are professional, adult staff. We suggest that you consider a 1:1 or 2:1 support for your camper if they have any specialty circumstances (toileting help needed, aggressive behaviours, ASD levels 2 or 3, run away from groups, etc.)
Camper # 3 Information

If applicable
T-shirt Size

XS - 4-5 yearsS – 6-7 yearsM – 8-9 yearsL – 10-11 yearsXL – 12-13 yearsAdult SAdult MAdult LAdult XLAdult 2XL
First Name
Last Name
Preferred Name
Date Of Birth

MonthDayYear
Date
Gender

MaleFemaleNon-binary / Non-conformingTransgenderPrefer not to respond
If Transgender, which gender does your child identify with?
Grade entering in the fall
School Attending
Has this camper ever attended camp before? When? Where?
Name of friends that this camper would want to be grouped with, if any.
Any medical problems, dietary restrictions that camp staff should be aware of? (Example: epilepsy, diabetes, ADHD/ADD, allergies, food intolerance, drug reactions, medications, etc.)
Does this camper have a life threatening allergy, or is an epi-pen required?

YesNo
Dietary restrictions

KosherVeggieHalal
General Behaviour: Is there anything that we should know about this camper's personality, behaviour, emotional development? Does the camper have any difficulties, fears, or anxieties?
Does this camper have any special needs or any behaviour challenges that we should know about? If so, please explain
Does this camper need extra supports?

NoYes, 1:1Yes, 2:1
1:1 and 2:1 supports are professional, adult staff. We suggest that you consider a 1:1 or 2:1 support for your camper if they have any specialty circumstances (toileting help needed, aggressive behaviours, ASD levels 2 or 3, run away from groups, etc.)
Camper # 4 Information
T-shirt Size

XS - 4-5 yearsS – 6-7 yearsM – 8-9 yearsL – 10-11 yearsXL – 12-13 yearsAdult SAdult MAdult LAdult XLAdult 2XL
First Name
Last Name
Preferred Name
Date Of Birth

MonthDayYear
Date
Gender

MaleFemaleNon-binary / Non-conformingTransgenderPrefer not to respond
If Transgender, which gender does your child identify with?
Grade entering in the fall
School Attending
Has this camper ever attended camp before? When? Where?
Name of friends that this camper would want to be grouped with, if any.
Any medical problems, dietary restrictions that camp staff should be aware of? (Example: epilepsy, diabetes, ADHD/ADD, allergies, food intolerance, drug reactions, medications, etc.)
Does this camper have a life threatening allergy, or is an epi-pen required?

YesNo
Dietary restrictions

KosherVeggieHalal
General Behaviour: Is there anything that we should know about this camper's personality, behaviour, emotional development? Does the camper have any difficulties, fears, or anxieties?
Does this camper have any special needs or any behaviour challenges that we should know about? If so, please explain
Does this camper need extra supports?

NoYes, 1:1Yes, 2:1
1:1 and 2:1 supports are professional, adult staff. We suggest that you consider a 1:1 or 2:1 support for your camper if they have any specialty circumstances (toileting help needed, aggressive behaviours, ASD levels 2 or 3, run away from groups, etc.)
Other Information
How did you hear about HTCC?
Is there anything else that you would like HTCC team to know about your camper(s)? We appreciate all information pertaining to any issues that the camper is experiencing, as this helps us provide programing that is helpful and specific to our campers.
Horse Therapy Centre of Canada offers optional Illness Insurance to secure your camp tuition investment. If your child has an extended absence or withdrawal from camp due to an illness or injury, Illness Insurance will cover a refund of some of your fees. This coverage begins after two consecutive days of absence, with proof of illness or COVID-19 testing. Would you like to add this insurance to your camper(s) registration? (Cost is $20/week/camper)

Yes, I want to insure my camp investmentNo, I do not want to insure my camp investment
Campers must wear an ASTM/SEI certified equestrian helmet during all equine activities. These are not bike helmets, they are specifically for equine activities. If your camper does not have one, we can rent you one for $25 per session. Please indicate below if you would like to rent a helmet.

Yes, I would like to rent a helmet for my camper(s)No, my camper(s) already have ASTM/SEI certified equestrian helmets
Discounts Available

Siblings Discount - -$50 off of second, third, fourth and fifth sibling
Camper(s) Release
List anyone, including parents, to whom your camper can be released. Please be sure to tell these people that they must provide identification upon pick-up.*
Terms and Conditions of Enrollment
Definitions as per Conditions of Enrolment:
a) Horse Therapy Centre of Canada Inc. their agents, owners, officers, affiliates, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively "HTCC").
b) All camp programs and activities, including but not limited to all sports, including but not limited to baseball, basketball, soccer, mini-golf, archery, trampolining, fine arts, visual arts, arts & crafts, ropes climbing, cooking, stable management, horse handling and games, equine assisted therapy, psychoeducation lessons, goat yoga, activities taught by third parties, swim and unstructured time (hereinafter collectively "Activities").

1. The first day of camp is Monday, March 11, 2024.

2. Applications cannot be confirmed unless accompanied by the required deposit or full payment of camp fees per child. Your child(ren) will only be permitted to start camp once fees are paid in full prior to the start of their camp session.

3. Refund policy:
a) Your deposit is refundable if we cannot confirm your application.
b) If you must cancel your application:
i. Your deposit is fully refundable up until December 1, 2023.
ii. After December 1, 2023 Camp Fees are NOT refundable and are NOT eligible for a credit for Summer 2024. ONLY if the Government does not allow camps to open will you receive a 100% refund on camp fees after December 1, 2023. If camps are shut down mid-season by the Government, you will receive a pro-rated refund for the days missed.

4. Given the current COVID-19 landscape in Ontario, we have removed the vaccine requirement for campers and staff for March Break 2024. HTCC will continue to monitor the situation as it develops with respect to COVID-19 in consultation with York Region Public Health and our health committee, and reserve the right to update this policy as required.

5. HTCC reserves the right to terminate the registration of any camper if, in the opinion of the Directors, it is in the best interest of the child or the camp. In such event, a proportional refund will be made.

6. I agree to allow my child to participate in all camp Activities and I give camp officials the authority to act on my behalf in case of an emergency.

7. The Parent and/or Legal Guardian (hereinafter collectively "Parent") grants permission for the Camper(s) as outlined in the Application for Enrolment (hereinafter collectively "Camper") to attend and participate in HTCC Activities and understands that these Activities entail known and unanticipated risks. These risks may be caused by Campers’ own actions or inactions, the actions or inactions of others participating in the Activities, including but not limited to other campers and/or staff, or the condition in which the Activities takes place. The Parent and/or Camper hereby fully accept and assume all such risks that could result in physical or emotional injury or damage to the Camper, to property, or to third parties and all responsibility for losses, cost, and damages incurred as a result of Campers' attendance at HTCC including participation in HTCC Activities.

8. The Parent and/or Legal Guardian agrees to keep their child(ren) home if they are sick, not feeling well for any reason, and/or exhibiting any symptoms of Covid-19 (or any other communicable disease). The child’s return to camp will be determined in conjunction with advice and consultation from local Public Health.

9. HTCC is not responsible for the loss or damage to Campers’ belongings, medication and/or equipment and/or other items while in transit or at HTCC.

10. The Parent and Camper hereby voluntarily releases, forever discharges, and agrees to indemnify and hold harmless HTCC and to waive any and all claims, demands, or causes of action, that the Parent and Camper have or may have in the future against HTCC and to release HTCC from any and all liability for any loss, damage, expense or injury that the Parent and Camper may suffer.

11. The Parent or Guardian hereby understands that HTCC will have zero tolerance for physical and/or verbal abuse towards any staff by Parents. Please respect the staff that look after the care of your children while at camp. Any person found in breach of this condition may be asked to terminate their child’s time at Camp. In the case of camper termination, a refund for the remaining days would be issued.

12. The Parent or Guardian hereby consents to the use by HTCC of the camper's photograph or video image for publicity purposes.

13. HTCC reserves the right to change or update our policies and/or programs and/or optional extras as the Ontario Ministry of Health may make recommendations and/or changes to the (Summer) Day Camp guidelines.

14. This document in conjunction with our Safe Camp Policy and Waiver of Liability in relation to Covid-19 (or any other Communicable Diseases) sets forth the entire agreement between HTCC, the Parent and the Camper and supersedes and replaces all other discussions, agreements, (whether written or verbal), contracts, representations, promises, negotiations or any other matter. This document can only be changed, modified or amended in writing by both parties.

15. If any portion of this document is found to be void and unenforceable, the remaining portions shall remain in full force and effect.
I agree to the terms and conditions of enrollment above

Yes, I agree with the terms and conditions of enrollment above
Today's Date

MonthDayYear
Date
Signature*

Clear
I also agree to the refund policy above

Yes, I agree with the refund policy above in #3.
Today's Date

MonthDayYear
Date
Signature*

Clear
Camp Safety Policy
In every aspect of camp, HTCC makes safety a top priority.

The Safe Camp Policy is designed to keep everyone safe and comfortable within their social environment at Camp. It covers many different aspects, including but not limited to camper, staff and parent behaviours, Ministry of Health/Public Health safety protocols, camp rules and aggressive conduct. The result of not listening or not complying with these rules could put your child, other children and/or staff’s safety, well-being and health in jeopardy.

The safe camp policy is as follows:

Campers need to follow rules and instructions that are designated by the camp and implemented by their counsellors, instructors, bus, swim and head staff.
Campers, parents and HTCC Staff must adhere to any and all health and safety protocols designated by the Ministry of Health and York Region Public Health that may be in place (including but not limited to guidelines related to Covid-19 or other communicable diseases).

HTCC will not tolerate aggressive behaviour of any kind from a camper (provoked or unprovoked) whether that be engaging in any physical and/or verbal action that has intent to harm or has caused harm to another individual. This also includes any aggressive behaviour (verbal or physical) from a parent or guardian targeted at ANY of our HTCC Staff.

In the event of not complying with any of the above:

The family will be contacted to discuss the incident and the expected change in behaviour that needs to be taken immediately. Our Unit Heads, Camper Relations Team and/or Directors work with the parents/guardians to develop a plan with recommended strategies to put in place. The goal is for all the children to be happy and safe at Camp!

Depending on the situation, a child with challenging behaviours may benefit from extra support provided by our one-on-one and two-to-one counselor program. This personal or semi-personal counsellor can help a child that is struggling in a group environment to become successful at Camp! Please note, however, 1:1 and 2:1 counselors are professional staff who are generally hired on an as-needed basis and we cannot guarantee that one will available mid-session. We highly recommend that if you do have any concerns about your child, you speak to HTCC camp office prior to March Break.

Any further incidents will result in the camper being sent home AT THE TIME OF THE INCIDENT, and parents will be expected to pick up their child within a 90-minute window. Depending on the severity, the child may be asked not to return to camp.

Following this, any further incidents will result in the child’s dismissal from Camp at the sole discretion of the Directors.

That being said, if the Director Team feels that either the parent/guardian(s) or camper’s behaviours compromise the health and/or safety of campers and staff, any of the above steps could be skipped and consequences could range from the immediate pick up of your child, missing a day of camp, or the immediate dismissal from camp at the sole discretion of the Directors.

While we strive to provide every child with a fun and positive camp experience this March Break, we must keep the safety of all our campers and staff top of mind.
I agree to the camp safety policy above

Yes, I agree with the camp safety policy above
Today's Date

MonthDayYear
Date
Signature*

Clear
Special Participation Agreement & Waiver of Liability

in relation to Risk of Coronavirus Infection (Covid-19) and/or any Communicable Disease while at Horse Therapy Centre of Canada Inc. ("HTCC")
Thank you for reading this Agreement carefully. It includes important information about Horse Therapy Centre of Canada Inc. (hereinafter referred to as 'HTCC') activities and describes certain protection sought by HTCC if you, your child, or another family member becomes ill or suffers some other loss due to infection of the CoronaVirus (COVID-19) and/or any Communicable Disease that may have been caused from being at HTCC or from being exposed by someone else who was at HTCC.

In consideration of the services of HTCC, I, the parent/guardian listed in this application for enrolment, acknowledge and agree as follows:

Activities:
The activities of HTCC include, but are not limited to, a variety of traditional sports, games, group therapy, horsemanship activities, general activities, crafts, activities with animals, and events that may make it impossible to consistently implement social distancing that may be recommended by any known government authorities. Although HTCC will make every effort to implement the guidelines in place by local government authorities and public health, Camp is a place where campers, counsellors, and staff are often in close contact and near each other every day.

Risks
Prior to the start of each camp day, the parent/guardian will have to ensure that their child(ren) is in good health and is not exhibiting symptoms of Covid-19 and/or any other Communicable Disease. HTCC will have a RN or RPN or student nurse onsite at all times. Any child or staff that does not feel well for any reason should not attend camp and remain at home and the camp should be notified. HTCC should be notified if any camper or staff is exhibiting symptoms of the Coronavirus (Covid-19) and/or tests positive for same and/or is exhibiting symptoms of a Communicable Disease and/or tests positive for same. In such a circumstance, HTCC will notify local public health authorities for further guidance and instructions.

Campers and staff will be exposed to the risk of contracting the Coronavirus (Covid-19) and/or possibly some other illness and/or Communicable Disease.

HTCC will remove activities that are not permitted under the public health guidelines (To Be Determined). The remaining activities though (swimming, sports, crafts and other arts, science, outdoor adventure) which are an integral part of the HTCC experience still carry risks and/or the potential for spreading of Coronavirus (Covid-19) and/or a Communicable Disease. If eliminated, campers would be deprived of the opportunity for the growth and development which HTCC and its campers and families expect.

Acknowledgement and Assumption of Risks:
I, the Parent/Guardian listed in this application for enrolment, have read and understand the HTCC activities and risk of exposure to the Coronavirus (Covid-19) and/or other Communicable Diseases. The risk of spreading Covid-19 and/or Communicable Diseases exists given that both campers and staff are in contact with each other and with other people outside of camp. I acknowledge and accept the risks that my child and/or members of my family in close contact (within 2 meters for more than 15 minutes) may be at risk of getting Coronavirus (Covid-19) and/or another Communicable Disease with my child being enrolled at HTCC.

AGREEMENTS OF RELEASE AND INDEMNITY: I, the Parent/Guardian listed in this application for enrolment, FOR MYSELF AND ON BEHALF OF MY CHILD(REN), HAVE READ AND UNDERSTAND THE POLICIES SET IN PLACE BY HTCC AND AGREE TO RELEASE AND FOREVER DISCHARGE (AGREEING TO MAKE NO CLAIM, AND NOT TO SUE) AND INDEMNIFY AND HOLD HARMLESS HORSE THERAPY CENTRE OF CANADA INC., AND THEIR RESPECTIVE OWNERS, MEMBERS, DIRECTORS, OFFICERS, EMPLOYEES, CONTRACTORS, AGENTS, REPRESENTATIVES, SUB-CONTRACTORS AND VOLUNTEERS (INDIVIDUALLY AND COLLECTIVELY REFERRED TO AS "RELEASED PARTIES") WITH RESPECT TO ANY AND ALL CLAIMS RELATED TO CONTRACTING THE CORONAVIRUS (COVID-19) OR ANY OTHER ILLNESS AND/OR INJURY AND ANY LOSS, BODILY INJURY, OR DAMAGES ASSOCIATED FROM IT WHICH I, ANY FAMILY MEMBER, OR MY CHILD(REN) MAY SUFFER, ARISING OUT OF OR IN ANY WAY RELATED TO HIM/HER BEING ENROLLED IN HORSE THERAPY CENTRE OF CANADA INC., AND ON OR OFF THE HORSE THERAPY CENTRE OF CANADA INC. PREMISES. THESE AGREEMENTS OF RELEASE AND INDEMNITY INCLUDE CLAIMS CAUSED OR CLAIMED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF A RELEASED PARTY. I UNDERSTAND THAT IN SIGNING THIS AGREEMENT I, FOR MYSELF AND FOR MY CHILD(REN) SURRENDER THE RIGHT TO MAKE A CLAIM OR FILE A LAWSUIT AGAINST A RELEASED PARTY, FOR PERSONAL INJURY AND EVEN DEATH.

Any dispute between HTCC or another Released Party and me or my child(ren) shall be governed by the laws of Ontario.

If any part of this agreement is found by a court of competent jurisdiction to be invalid, the remainder of the agreement nevertheless will be in full force and effect.

I, the Parent/Guardian listed in this application for enrolment have read and accept the terms and conditions of this Agreement, and acknowledge and agree that it shall supersede and replace all other discussions, agreements (whether verbal or written), contracts, representations, promises, negotiations or any other matter. This document can only be changed, modified or amended in writing by both parties. I also agree that this document is effective upon me and my child(ren), and our respective heirs, personal representatives, estates and family members once my child(ren)’s is enrolled in HTCC.
I agree to the Special Participation Agreement and Waiver of Liability above

Yes, I agree with the Special Participation Agreement and Waiver of Liability above
Today's Date

MonthDayYear
Date
Signature*

Clear
Payment Information

PLEASE NOTE: You will receive a detailed quote once your camper's application has been approved and prior to payment being processed.
Method of Payment

CashChequeEmail Money TransferCredit Card (3% fee applies)
Email Address for EMTs:

office@horsetherapycanada.com

Mailing Address:

Horse Therapy Centre of Canada
15443 9th Line,
Stouffville, ON L4A 7X4

Office hours for drop-offs:

Monday - Friday 9:00 am - 7:00 pm

All credit card payments will have a 3% service fee added to the total.
Credit Card Details
Name of Card Holder

First NameLast Name
Address

Street Address

Street Address Line 2

CityProvince

Postal Code
Type of Card
CC Number
CC Expiration
CVC Code
ALL DETAILED INVOICES FOR INSURANCE PURPOSES WILL BE RECEIVED ONE WEEK AFTER YOUR CAMPER'S LAST DAY OF CAMP. THESE INVOICES HAVE THE REGISTRATION NUMBER FOR OUR REGISTERED SOCIAL WORKER ON THEM.
Should be Empty:

March Break Camp Registration

General Family Information

Parent / Guardian # 1 Information

Parent / Guardian # 2 Information

Emergency Contact # 1

Emergency Contact # 2

Camper # 1 Information

Camper # 2 Information

Camper # 3 Information

Camper # 4 Information

Other Information

Discounts Available

Camper(s) Release

Terms and Conditions of Enrollment

Camp Safety Policy

Special Participation Agreement & Waiver of Liability

Payment Information

Credit Card Details