Summer Camp Scholarship Application

Questions

If you have questions about this application or have any other questions, please reach out to Lisa McDonald directly at info@oldmcdonaldsfamilyfarm.ca or 705-492-2344
Scholarship

The following application must be completed by April 1, 2024 to be considered to receive a scholarship to our summer camp. This application does not guarantee your child's scholarship. We will choose a recipient on Friday, April 5, 2024. Requirements Transportation is not provided. Your child can be dropped off between 8-9am and picked up between 4-5pm. Lunch is not provided. Your child may bring a lunch with them each day.
Code of Conduct

Behaviour Guidelines Campers shall be responsible for their words and actions. Campers shall be respectful of others. Campers shall follow directions from staff members at all times. Campers shall leave all electronic devices at home such as iPods, handheld computer games, MP3 players. Campers shall not venture off with other campers without notifying a staff member. Prohibited Behaviours Foul or disrespectful language towards staff or fellow campers. Failure to adhere to staff’s direction/behaviour guidelines and rules. Reckless behaviour that could result in physical/emotional harm to themselves, fellow campers or staff. Steps taken for failure to follow these behaviour guidelines Staff will redirect the camper to more appropriate behaviour. The camper will be reminded of the behaviour guidelines. If the behaviour persists, staff will discuss the problem with a parent/guardian. The staff will document the situation. The written documents will include what the behaviour problem is, what provoked the problem, and the corrective action is taken. If the problem persists to the point where a second phone call becomes necessary, the Camp Director may find it necessary to have the camper picked up early from camp. If a camper’s behaviour at any time threatens the immediate safety of him/her, other campers, or staff, the parent/guardian will be notified and expected to pick up the child immediately. Failure to comply with the Code of Conduct may result in the removal from the program and/or additional fees. There will be no refunds given for campers who are removed from the program due to violations of the Code of Conduct.
Name of Person Filling Out This Application*

First NameLast Name
Relationship To Child*

CaseworkerCASAFoster ParentAdoptive ParentBiological ParentRelativeOther
Child's Information
Child's Name*

First NameLast Name
Preferred Name (if child has one)*
Gender*

MaleFemaleOther
Birthdate*

MonthDayYear
Age at Time of Camp*

5 years old6 years old7 years old8 years old9 years old10 years old11 years old12 years old
Parent/Guardian Information
Mailing Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent or Legal Guardian #1*

First NameLast Name
Relationship to Child*
Best Phone Number*

Area CodePhone Number
This phone is a:

Cell PhoneWork PhoneHome Phone (land line)
Parent/Guardian #1 Email Address*
Parent or Legal Guardian #2

First NameLast Name
Relationship to Child
Parent or Legal Guardian #2 Best Phone Number

Area CodePhone Number
This phone is a:

Cell PhoneWork PhoneHome Phone (land line)
Background/Behavior Information

Please fill this out to the best of your ability. We as RFKC staff want to make sure your child has a safe, healthy, fun time at camp. This information is extremely helpful!
Why would this child's attendance at our camp be important? Why would you like to see him or her attend camp?*
Please let us know if any of the following learning difficulties exist for this child.

Hearing impairmentVision impairment (that would affect time at camp)Dyslexia or reading difficultiesDon't know about learning difficultiesOther
If these learning difficulties will negatively affect this camper's week at camp - or if this information would help our team make camp better for your child - please explain.
HISTORY/STORY: Please share this child's history or story so we can understand how our camp could impact them.
** Please tell us about this child's history or story. *
Please tell us what this child's interests, passions, loves, etc. are so our Staff can make camp even more special! (i.e. Loves sports, favorite color is purple...whatever!)*
Medical History + Prescription Medication Information
List all known allergies to food, plants, medications, animals, etc.*
Illnesses and Medical Complications Past or Present (check all that apply)*

Respiratory ProblemsMuscuoskeletal AllergiesFood AllergiesMedicine AllergiesTopical Allergies (lotion, sunscreen, etc.)Dizzy Spells and/or FaintingFoot ProblemsBack ProblemsSeizure DisordersAnaphylactic ShockBalance ProblemsAsthmaADD or ADHDHypoglycemiaHeart or Circulation ProblemsPulmonary EdemaHay FeverPoison Oak/Poison Ivy AllergiesType 1 Diabetes (previously insulin-dependent)Type 2 Diabetes (previously non-insulin dependent)Insect Bite Allergies (i.e. mosquitoes, bees, wasps, etc.)Recent SurgeryRecent Broken BonesOther
Please explain each medical issue you checked above. (If you did not check anything, please say DOES NOT APPLY."*
What specific activities should be DISCOURAGED for medical reasons while at camp?*
NON-APPROVED Medications / Treatments: Check ONLY those you DO NOT WANT the medical team to administer. Please refrain from the following...*

Sunblock/SunscreenInsect RepellantRash OintmentTylenol or AdvilAntiseptic OintmentBandaidsAnti-Itch CreamHydrogen PeroxideRubbing AlcoholAntihistamineOther
Please explain why you said NO to the medications you checked above. (If you did not check any, just say DOES NOT APPLY.)*
Prescription & Over-the-Counter Medications
Will your child require medication throughout the day?*

YesNo
If yes, I understand that it is my responsibility as a caregiver to make sure that all instructions are clear and that the necessary dosage is adequately supplied. I authorize Old McDonalds Family Farm staff to administer the medications.*

Yes, I understand that sharing medical info, medications, and dosages are my responsibility.No, I do not understand that sharing medical info, medications, and dosages are my responsibility.N/A
Please Read Carefully
I recognize that my participation in the program/activity for which I register may include a risk to my health or a risk of injury. I hereby willingly assume such health risk or risk of injury for myself or for the person(s) for whom I am in law responsible, and I assume full responsibility before, during and after my/their participation in the program/activity. In consideration of the acceptance of my application and the permission to participate in the program/activity, I, for myself, my heirs, executors, administrators ,successors and assigns HEREBY RELEASE, WAIVE, AND FOREVER DISCHARGE Old McDonalds Family Farm, all other organizations, associations and companies associated with any of the programs offered by Old McDonalds Family Farm, and all their respective employee and volunteers OF AND FROM ALL claims, demands, losses, damages, costs, actions and other proceedings whatsoever, whether in law, statute or equity, in respect of death, injury, loss or damage to me or my property, howsoever caused, except to the extent caused by or attributable to the negligent or intentional acts of the farm Indemnitees, arising or to arise by reason of my participation in the program or any of its associated activities. By clicking yes, I acknowledge that I have read, that I understand and that I agree with this waiver.*

YesNo
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