Day Camp Registration Form

Parent/Guardian Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

We request all campers arrive with sunscreen applied. Please also send a hat for your camper and provide consent for re-application of sunscreen if needed.

How Many Children Would You Like To Register?

You can register up to 6 children using this form. To register more than 6, please call 613-258-3583 ext. 200

Child's Name

Date of Birth

Current Age

Gender

Sunscreen Authorization

Child's T-Shirt Size

2nd Child's Name

2nd Date of Birth

2nd Child's Age

2nd Child's Gender

Sunscreen Authorization for 2nd Child

2nd Child's T-Shirt Size

3rd Child's Name

3rd Child's Date of Birth

3rd Child's Age

3rd Child's Gender

Sunscreen Authorization for 3rd Child

3rd Child's T-Shirt Size

4th Child's Name

4th Child's Date of Birth

4th Child's Age

4th Child's Gender

Sunscreen Authorization for 4th Child

4th Child's T-Shirt Size

5th Child's Name

5th Child's Date of Birth

5th Child's Age

5th Child's Gender

Sunscreen Authorization for 5th Child

5th Child's T-Shirt Size

6th Child's Name

6th Child's Date of Birth

6th Child's Age

6th Child's Gender

Sunscreen Authorization for 6th Child

6th Child's T-Shirt Size

In case of emergency please contact

Allergies or Medical Conditions:

Other information that you would like us to know:

Media Release:

I hereby authorize The Governing Council of The Salvation Army Canada and Bermuda Territory and all associated and related charities to use photographs, video, facebook and audio footage of my child to be used by The Salvation Army for any marketing, public relations and promotional purposes, which they may, in their sole and absolute discretion, deem appopriate.

Waiver:

I hereby give permission for my child(ren) to participate in The Salvation Army Magnified Day Camp. I furthermore assume absolute responsibility and liability for such activities and, we agree to indemnify and save harmless the Kemptville Salvation Army or any of their officers, members or adherents, representatives, agents, consultants and independent service providers from any and all liability for any and all actions, losses, damages and expenses (including, without limitation, the loss, damage or theft of money or property), personal injuries, or deaths, however, caused. I also understand that in the event of a medical emergency the adult supervisors have my permission to use their best judgement to authorize emergency medical procedures.

Acknowledgement:

By submitting this form, I acknowledge that I have read the above media release and waiver and agree to its terms.

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