Camp Promise Barrie After School Program Application Form

Residence Information
Current Address*

Street Address

CityProvince

Postal Code
Parent/Guardian Information*

First NameLast Name
Cell Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Other Phone
Please enter a valid phone number.Format: (000) 000-0000.
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.Format: (000) 000-0000.

YesNo
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 may include transportation by vehicle or walking 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. Photographs or videos of your child taken during program may be used for promotional material.
YesNoType option 3Type option 4
Date

MonthDayYear
Date
Signature*

Donation (optional):

prevnext( X )
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

Choose from one of the PayPal options to make your payment.

Program Information