Summer Camp 2023 Registration Form

Monday, August 14, 2023 (9:30am till 3:00pm) - Crafts, cooking, spray park & fun at Lou SoppitTuesday, August 15, 2023 (9:30am till 3:00pm) - Crafts, cooking, spray park & fun at Lou SoppitWednesday, August 16, 2023 (9:30-till 3:00pm) - WoodworkingThursday, August 17, 2023 (9:30am till 3:00pm) - Rock Public LibraryFriday, August 18, 2023 (9:30am till 3:00pm) - Exploring & Adventure at the National Historic Site

Cost:

CPF Members: $10/day of camp

CPF Non-members: First Day of Camp: $35 (gives you a 1 year CPF Membership)

-additional camps $10/day of camp

Example: If you are registering for all camps the cost would be:

CPF member: $50

Non-members: $75 ($25 for 1 year CPF membership, $10 per day of camp)

To reserve your spot, all registrations must be prepaid. Etransfer can be made to cpf.rmh@gmail.com or registration forms will be available at Copper Creek Cafe (payment by cheque only).

Password: camp2022

Comment: child's first and last name

Registration fees are non-refundable.

CAMPER'S INFORMATION

Child's Name

First NameLast Name

Child's Birth Date:*

Date

Child's Grade:*

example Grade 4

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

PARENT/GUARDIAN'S INFORMATION

Name*

First NameLast Name

Parent/Guardian's Phone Number*

Please enter a valid phone number.

Email*

example@example.com

EMERGENCY CONTACT's INFORMATION

Emergency contact's Name*

First NameLast Name

Relationship to child*

Phone Number*

Please enter a valid phone number.

Alt.Phone Number

Please enter a valid phone number.

Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.*

Is the child prescribed an inhaler? If yes, please explain any instructions.*

Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by CPF Rocky Chapter during the selected camp. In exchange for the acceptance of said child’s candidacy by CPF Rocky, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless CPF Rocky 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 camp sessions. In case of injury to said child, I hereby waive all claims against CPF Rocky including all volunteers and affiliates, all participants, 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 extracurricular activities, including sports. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

I acknowledge and have read the above information.

Medical Release and Authorization As Parent and/or Guardian of the named child, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named child. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to CPF Rocky and its affiliates including Directors and volunteers to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

I acknowledge and have read the above information.

Photo Release - Consent to Photography and to Disclose Identity I hereby grant and give Canadian Parents For French and CPF Rocky Chapter permission to take photos or videos (digital or otherwise) of myself and all other registered participants and to reproduce the likeness of myself and all other registered participants for promotional and fundraising materials, publications, websites, and other consistent purposes. Editing, publication, distribution, broadcast and use of this material shall be at the sole discretion of Canadian Parents For French and CPF Rock Chapter, worldwide, in perpetuity or you withdraw your consent. Individual(s)' identity, MAY or May NOT be included in the resources listed below as developed and published in print, electronic, or digital format, including and authorized Skills Canada, CPF Alberta and CPF Rocky Chapter's website or social media platforms, such as cpfab.ca. This agreement will be placed on file in the coordinating office and retained in accordance with approved records. Also note that consents may be revoked at any time by so indicating, in writing, to Canadian Parents for French Alberta.

I accept, acknowledge and have read the above information.

Signature od Parent or Guardian*

Please Print Name Parent or Guardian*

First NameLast Name

YesNoOther

If you chose other, please explain.

Summer Camp 2023 Registration Form

REGISTRATION CLOSES AUGUST 4, 2023