Camper Registration Form

Camper Registration Form
Camper Information
Full Name*

First NameLast Name
Birthday*

DayMonthYear
Date
Health Card Number (Optional)
Does {fullName3} have any allergies we should be aware of?*

YesNo

Allergy Info
Please specify:
Does {fullName3} know how to use an epipen?

YesNo

Allergy Info End
Workshops includes various activities on uneven terrain; does your child have physical, cognitive, emotional or behavioural limitations/ challenges that would require assistance and/or modification to the program to enable him/her to participate fully?*

YesNo

Health Info
Please specify:

Health Info End
Does {fullName3} have any dietary preferences?*

YesNo

Dietary Preferences
Please specify:

Dietary Info End
Anything else we should know about {fullName3}?

Parent / Guardian 1:
Full Name*

First NameLast Name
Phone Number*
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent / Guardian 2:
Full Name

First NameLast Name
Phone Number
E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

End
Emergency Contact:

In case of an emergency, we will make every effort to contact the custodial parent(s), if for some reason they are unreachable, please include an alternate contact (Grandparent/Caregiver/Neighbour etc.)
Full Name*

First NameLast Name
Phone Number*
Relationship to Camper*
Camp Information
ARRIVAL/ DEPARTURE TIMES:
Drop-offs – between 8:30 A.M. – 9:00 A.M.
Pick-ups – between 5:00 P.M. – 5:30 P.M

CANCELLATIONS:
If you need to cancel your booking, please note that cancellations made more than 14 days before the start of camp will incur a 20% administration fee, which will be deducted from your refund. However, if Paper Kite Farm is required to cancel the workshop for any reason, you will receive a full refund without any deductions.

SAFTEY DISCLAIMERS:
Participation in any program which involves physical activity exposes the camper to certain risks and dangers. Farm activities also involves certain inherent risks. These include interactions with animals, navigating uneven terrain, and the use of farm tools. Accidents and injuries are always a possibility, and it is impossible to foresee and protect the camper from all conceivable dangers.

Hastings Prince Edward Public Health has monitored for ticks in the County since 2012 and confirmed the presence of established blacklegged tick populations, a significant percentage infected with the bacterium that causes Lyme disease. Please note that early diagnosis and treatment of Lyme disease increases the chance of a successful outcome. In an event of finding a tick on your child, we will remove and promptly contact you immediately whether to seek medical attention is necessary. We will remind your child of how to protect themselves and proper ways to check themselves correctly.
Photography Release
I allow Paper Kite Farm and their staff to use {fullName3}'s image, voice, and related information for promotional or reporting purposes in any media worldwide. This includes photos, performances, and biographical details. I understand that I will not receive any payment for this.*

YesNo
Statement of Consent & Waiver
By signing below, I hereby agree and declare that I am the legal parent/guardian of {fullName3} and hereby consent to the their participation in the activities that are described to me in registration process. I understand that activities of the kind described may result in physical injury to them but nonetheless specifically request that they be allowed to participate in those activities.

I hereby affirm that {fullName3} has no conditions that would make it unsafe for them to participate in the camps.

If {fullName3} requires any emergency medical treatment or procedures during the activities, I hereby consent to activity supervisor(s) to make any decision and take any action to arrange for such procedures or treatments in the discretion of the activity supervisor(s).

I hereby agree and declare that I have carefully read and understand the scope of the summer camp activities and I consent to the participation of the above-named child to these activities.

Any type of injury that may occur to {fullName3} without the fault of the camp management and activity supervisors, the camp management cannot be held responsible for any harm that may occur to the child without the fault of the camp management and activity supervisors.
Name*

First NameLast Name
Signature*

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Camper Registration Form

Camper Information

Emergency Contact:

Camp Information

Photography Release

Statement of Consent & Waiver