Forms | Alpine Academy of Rockford

Location
530 Victoria Ave, Unit R
Chatham, ON, N7L 3B7

Event Date
March 5, 2024 - April 23, 2024
Every Tuesday for 8 weeks.

Start Time
3:00PM

End Time
6:00PM

Details
Drive to the back of the building. Enter in the side door. You will see Lincks' Culinary Camp poster on the entrance door.

Cost Per Person
$45

Permission Form Due Date:
February 21, 2024
Student Information
Participant First Name*
Participant Last Name*
Participant Age*
Questions for the Participant:

0 = No experience 5 = Expert
Select Level of Knowledge of cross contamination:*
Select Level of the Ontario Food Handlers Guide:*
Select your level of knowledge of kitchenware & appliances:*
Select your level of knowledge of being able to cook a meal for yourself:*
Are you committed to attending all 8 sessions?*
Is there anything you would specifically like to learn?
Parent Information
Parent / Guardian First Name*
Parent / Guardian Last Name*
Email Address*
Phone Number
Are you able to provide transportation for your youth to attend all 8 sessions?*

YesNoYouth has own transportation
Emergency Contact Information
Name*
Relationship
Phone Number*
Medical Information
Important Medical Information the Program Supervisor Should Know
Authorization Signature
RELEASE OF LIABILITY. PLEASE READ BEFORE SIGNING.*

This agreement releases Lincks’ Culinary Camp, through Linck,Child, Youth & Family Supports, from all liability relating to injuriesthat may occur on site and/orduring one of the 8 sessions. By signing this agreement, I/Participant agree to hold LCC& Linck, Child, Youth & Family Services entirely free from anyliability, including financial responsibility for injuries, regardless of whether injuries are cause by negligence.I/Participant acknowledge the risks involved in this activity. These include but are not limited to cuts, scrapes, and burns. Additionally, I/Participant do not have any conditions that will increase my likelihood of experiencing injuries while engaging in this activity.I acknowledge that Lincks’ Culinary Camp/Linck, Child, Youth & Family Supports will not provide a refund if I/Participant does not attend all 8 sessions.By signing below, I forfeit all right to bring a suit against Lincks’ Culinary Camp/Linck, Child, & Youth Services. I will also make every effort to obey safety precautions as listed in writing and as explained to me verbally. I/Participant will ask for clarification when needed.I agree that payment is to be submitted by March 5, 2024. Failure to submit payment will result in loss of spot.
Optional: I agree to be photographed, filmed and/or taped and used by the Lincks’ Culinary Camp/Linck, Child, Youth & Family Services for promotional/marketing purposes.*

YesNo
Parent/Guardian Signature*
Linck, Child, Youth & Family Supports

Program by: Family & Youth Engagement Team

495 Grand Ave. West Chatham, ON, N7L 1 C5 | (519) 352-0440 ex. 4298

Linck, Child, Youth & Family Supports | CKYS Instagram |
Should be Empty:

Student Information

Questions for the Participant:

Parent Information

Emergency Contact Information

Medical Information

Authorization Signature