Maple Leaf Summer Camp

Campers Name*

First NameLast Name

Birth Date*

MonthDayYear

Age*

Gender

Select All Weeks That Apply*

Week 1: Super Sized (July 2nd - 5th) *Short Week* [$360] [Available]Week 2: Water World (July 8th - 12th) [$450] [Waitlist]Week 3: Imagine This (July 15th - 19th) [$450] [Waitlist]Week 4: Amazing World Race (July 22nd - 26th) [$450] [Waitlist]Week 5: Super Hero Academy (July 29th - August 2nd) [$450] [Waitlist]Week 6: Time Travellers (August 6th - 9th) *Short Week* [$360] [Waitlist]Week 7: Game Show Mania (August 12th - 16th) [$450] [Waitlist]Week 8: Excursion Camp 1 (August 19th - 23rd) [$500] [Waitlist]Week 9: Excursion Camp 2 (August 26th - 30th) [$500] [Waitlist]

Extended Day Care Hours*

Before Care: 8am-9am $50/WeekAfter Care: 4pm-6pm $80/WeekN/A

Payment Option*

Payment In FullDown Payment (25%) (No Longer Available)Monthly Payments (No Longer Available)

Payment Method*

Pay By Credit Card (3% Transaction Fee Will Apply)Pay By E-Transfer (No Fee)

Please Indicate Any Further Modifications You Will Require With Your Summer Camp Package

Parent/Guardian Information

Primary Contact's Name*

First NameLast Name

Cell Number*

E-mail*

Secondary E-mail

**Secondary Emails Are Ideal For Additional Parents/Guardians To Remain Informed**

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact Information

Secondary Contact's Name

First NameLast Name

Relationship

Phone Number

E-mail

Please List Anyone Else Who Is Authorized To Sign Your Child In And Out Of Summer Camp.

Does Your Child Have Any Allergies, Chronic illnesses, or Medical Conditions? If Yes, Please Describe.

Is Your Child Prescribed An Inhaler Or Epipen? If Yes, Please Explain Any Instructions.

Is There Anything Else That We Should Know About Your Child?

I understand that Maple Leaf Summer Camp will take photographs and/or recordings of camper(s) solely for the use of creating weekly thematic videos that are distributed to parents and guardians every week for their enjoyment. Said photographs and thematic videos may also be used on the Maple Leaf Summer Camp website to advertise camp activities. If you do not wish for you camper(s) to be posted onto the Maple Leaf Summer Camp website for any reason please email your concerns to Matt, the Camp Director at matt@mapleleafsummercamp.com, and he will ensure that your preferences are met. By checking “Yes”, I grant my understanding and permission until otherwise specified.*

Yes

How Did You Hear About Us?*

Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Maple Leaf Summer Camp Inc. during their 2024 summer programing operations. In exchange for the acceptance of said child’s candidacy by Maple Leaf Summer Camp Inc., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Maple Leaf Summer Camp Inc. and all of its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of any camp activities facilitated by Maple Leaf Summer Camp Inc. incluidng but not limited to, traveling to and from field trips and/or mini excursions destinations. In case of injury to said child, I hereby waive all claims against Maple Leaf Summer Camp Inc., including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.

Medical Release and Authorization As Parent and/or Guardian of the named camper, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named camper. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to Maple Leaf Summer Camp Inc. and its affiliates including directors, coaches and team members to provide any needed emergency treatment, if present, prior to the child’s admission into the care of a medical professional or medical facility. Release authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Confirmation BY SUBMITTING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE TO THE ABOVE MENTIONED ACKNOWLEDGEMENTS AND AUTHORIZATIONS THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Maple Leaf Summer Camp

Payments Are Not Processed On This Form

Medical Information

Media Release / Photo Consent