Camp Promise Barrie After School Program Application Form

Camp Promise Barrie After School Program Application Form

Fall 2024 - Spring 2025
Program Information
Start of Program: September 11, 2024

End of Program: May 15, 2025

Cost: Free

Program location: Barrie Free Methodist Church, 290 Cundles Rd E

After School Program takes place on Wednesdays and Thursdays from 3:30pm-5:30pm weekly from September to May, following the school board calendar. Programming includes a healthy snack, songs, stories, crafts, games and a learning time. In learning time literacy, math, drama and science skills are explored in a fun and exciting way to assist with student's success in the classroom.

We pick up from Codrington and Steele St on Wednesdays and from Oakley Park and Maple Grove schools on Thursdays. Students from any other location will need to make arrangements for drop off after school at the program location.

*Please note, parents are responsible for pick up at the program location at 5:30pm.

We look forward to having you join us at Camp Promise!
Contact Information
Allison Jacobson

Cell Phone: 416-677-4274

Email: info@camppromisebarrie.com
Program Days and Locations
Please pick the day and location where your child will be picked up from (students are eligible to attend one day per week)*

Wednesday - Codrington Public SchoolThursday - Oakley Park Public SchoolWednesday - Steele St Public SchoolThursday - Maple Grove Public SchoolWednesday - Parent/Guardian drop offThursday - Parent/Guardian Drop Off
Child Information*

First NameMiddle Initial/NameLast Name
Birth Date*

MonthDayYear
Age*
Gender*
Health Card Number
Medical Conditions/ Allergies/ Disabilities/ Special Needs (any support at school)*
Name of School*
Grade*

Residence Information
Current Address*

Street Address

CityProvince

Postal Code
Parent/Guardian Information*

First NameLast Name
Cell Phone*
Please enter a valid phone number.
Other Phone
Please enter a valid phone number.
Email*
example@example.com
Emergency Contact Information
Primary Emergency | Contact Name*

First NameLast Name
Primary Emergency | Relation to child*
Primary Emergency | Phone Number*
Please enter a valid phone number.

As per Ontario's requirements, a child needs a Booster Seat if they are below 80 lb (36 kg) in weight and under 4ft 9in (145 cm) tall. Based on this information, does your child need a Booster Seat during transportation from school to camp facilities?*

YesNo
Photographs or videos of your child taken during program may be used for promotional material. Please pick one of the following options.*

Yes, I grant permission for my child to be in the photographs and videos that may be used for promotional material.No, I do not grant permission for my child to be in the photographs and videos that may be used for promotional material.
Acknowledgement

I hereby grant permission for my child to participate in all activities of this program (which many include outings during program hours) and release Camp Promise staff from any and all liability, claims, demands, personal injury, sickness, death, as well as property damage and expenses of any nature whatsoever, which may be incurred by the child participant. Further, I grant permission to Camp Promise staff to authorize medical personnel to carry out the emergency procedure on my child in the case that I or the emergency contact, cannot be reached at the time of the incident. I have read and understood the waiver.
Date

MonthDayYear
Date
Signature*

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Donation (optional):

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CADCamp Promise After School Program is offered at no cost to all families. However, if you would like to to contribute to the on-going work of this non-profit, you can do so by putting the amount above. Any contribution is appreciated and helps us to bless more families in Barrie.

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

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Camp Promise Barrie After School Program Application Form

Program Information

Contact Information

Program Days and Locations

Residence Information

Emergency Contact Information

Acknowledgement