Staff Registration - Zgloszenie

Please ensure you have read the camp info documents before filling out this form.

1. Counsellor/Staff Form

Name/ Nazwisko i imię *

First NameLast Name

Position/Funkcja*

Please select from list

Birth Date/ Data Urodzenia *

DayMonthYear

E-mail*

example@example.com

Phone Number*

Health Card#*

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please list names of your child/children attending, if applicable.

2. Emergency Contact Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Do you have any allergies? If yes, please describe.

Electronics Policy

At our summer camp, we have a no electronics policy to ensure that our campers fully engage with the outdoors and each other. We believe that unplugging from technology can help promote social interaction, creativity, and self-discovery. We ask that campers leave all electronics at home, including cell phones, tablets, laptops, and gaming devices.

As camp staff we aim to set a good example for our campers. We understand that staff occasionally need to use their cell phones to communicate with one another. We ask that the use of cell phones be limited to necessary communications only.

Release of Liability and Waiver and Consent for Use of Photographs

IN CONSIDERATION of ZHRwK admitting myself into their program, I hereby consent to my participating in all programs and activities of ZHRwK. I FURTHER HEREBY release ZHRwK, its instructors, agents, volunteers, employees and any other persons representing ZHRwK from any liability, claims, demands, damages, actions or causes of action which I may hereafter have against ZHRwK, for or by reason of, or in any way arising out of any accident, loss, injury or damage which my child or me may suffer while attending at or participating in any program or activity of ZHRwK in the amount exceeding the sum payable under the insurance policy purchaser by ZHRwK, and this shall constitute my full and final release. I understand that photographs, videos and voice recording of my child or me may be taken during scouting activities by organizers and that the resulting photographic images, videos and voice recording may be used in organization newspapers and other promotional material including the polish language press without further notice to me, and I consent to such use of these photos.

I have read and fully understand the nature of this document and fully understand and accept the contents of this Release of Liability and Waiver and Consent for Use of Photographs and are executing this document voluntarily in full knowledge of its legal effect.

Signature*

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Payment

ENGLISH

I understand that the compensation for the work I'll be doing at Akcja Letnia 2023 is either a free stay for one child at the camp, or a voucher of $60 per full day of work, which can be used towards holidays or camps at Kaszuby (ZHR). If I'm registering more than one child to the camp, I'll need to pay a fee for each additional child (First child free, second child pays the second rate - as outlined in the provided information). Additionally, if my child/children are not affiliated with ZHRwK, there will be an additional fee for each of them as stated in the application, which is $60.

POLISH

Przyjmuję do wiadomości, że wynagrodzeniem za moją pracę na Akcji Letniej Kaszuby 2023 na powierzonej mi funkcji jest bezpłatny pobyt mojego jednego dziecka na kolonii/obozie, lub też jeśli nie posiadam dziecka otrzymam voucher do wykorzystania na Kaszubach (wczasy, biwaki) w wysokości $60 za pełny dzień pracy. Jeśli zabieram ze sobą na obóz/kolonię więcej niż jedno dziecko, obowiązuje za nie opłata jak za 2-gie dziecko w rodzinie. Jesli troje dzieci, to jak za 3-cie dziecko w rodzinie, itd. . (patrz informacje). W przypadku kiedy moje dziecko/ci jest/są niezrzeszone w ZHRwK obowiązuje za każde z nich dodatkowa opłata (patrz zgłoszenie) - $60

Will you be taking the bus to camp? Please add $75.00 each way. *You may redeem ZHR vouchers to cover the expense of the bus**

No, I will be using my own transportation to get to camp.Yes, I will be taking the bus ($150.00)I will be taking the bus TO camp only on July 8th . I have alternative transportation to get home. ($75.00)I will be taking the bus FROM camp only on July 22nd. I have alternative transportation to get to camp. ($75.00)

BUS SCHEDULE

July 8th, 2023 - Departure Times

8:00 AM - Etobicoke

9:00 AM - Scarborough

10:15 AM - Peterborough

July 22nd, 2023 - Arrival Times

5:30 PM - Peterborough

6:45 PM - Scarborough

7:30 PM - Etobicoke

If taking the bus: Where would you like to be dropped off/picked up?

Etobicoke - Parking Lot beside Christ the King Church. 3674 Lake Shore Blvd. W.Scarborough - Parking Lot beside National Sport (NW corner) 1457 McCowan RdPeterborough - Parking Lot beside Country Style - 779 Hwy 7

PAYMENT - Please list transportation costs, if paying by cheque or etransfer. If you are using ZHR vouchers, DO NOT insert a number below, and skip to the next field.*

Using ZHR Vouchers? Please specify amount and indicate whether they will be mailed or presented at camp.

*Important* any vouchers must be presented on the first day of camp, or mailed to Dhna Elżbieta Łyszkiewicz - 207 Wilmot Trail, Newcastle, ON, L1B 1A9 by July 22nd, 2023

I acknowledge that any violation of the Camp Regulations listed below will result in my immediate dismissal, at my personal expense:

Failure to comply with the Camp Policies & Regulations
Possession and/or use of cigarettes, e-cigarettes, alcohol or drugs
Continual disruption of the camp's program
Being in danger of harming oneself or a camper
Inviting unauthorized guests
Continual use of vulgar language or cursing

Confirmation

By submitting my application in the summer camp program, I agree to the terms and conditions set forth in the policies. I understand that this acknowledgement serves as a binding agreement between myself and the summer camp.

In agreeing to these terms, I declare that I have read and understood the participant's commitment and Camp Regulations and agree to comply with them.

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Full Name*

Date*

Date

Signature*

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STAFF REGISTRATION FORM (18+)