Camp Promise Barrie After School Program Application Form
Fall 2023 - Spring 2024
Program Information
Start of Program: September 13, 2023 End of Program: May 17, 2024 Cost: Free
Contact Information
Caroline Salvi Phone: 647-871-4839 Email: info@camppromisebarrie.com
Program Days and Locations
Please pick the days/location where your child will be picked up from
*
Wednesday - Codrington Public School
Wednesday - Parent/Guardian Drop Off
Wednesday - Steele Street Public School
Thursday - Parent/Guardian Drop Off
Thursday - Oakley Park Public School
Friday - Parent/Guardian Drop Off
Friday - Maple Grove Public School
Child Information
*
First Name
Middle Initial/Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Age
*
Gender
*
Please Select
Female
Male
Health Card Number
Medical Conditions/ Allergies/ Disabilities/ Special Needs (any support at school)
*
Name of School
*
Grade
*
Back
Next
Residence Information
Current Address
*
Street Address
City
Province
Postal Code
Parent/Guardian Information
*
First Name
Last Name
Cell Phone
*
Please enter a valid phone number.
Home 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 Name
Last Name
Primary Emergency | Relation to child
*
Primary Emergency | Phone Number
*
Please enter a valid phone number.
Other Phone
Please enter a valid phone number.
Back
Next
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?
*
Yes
No
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
-
Month
-
Day
Year
Date
Signature
*
Continue
Continue
Should be Empty: