Milton Challenge Registration

CHALLENGE MILTON

Registration Form

(September 2025 - June 2026 season)

Sponsored by Regnum Christi, Love Christ, Serve People, Build the Church

Meetings held every Friday from 7pm to 9pm at:

Queen of Heaven Catholic Elementary School
311 Savoline Blvd., Milton, ON L9T 7M4

Payment options

1 Installment Plan

Due on September 19, 2025

One girl $225 - Two Girls $400 - Three Girls $600

3 Installment Plan

Due on September 19, 2025 / October 19, 2025 / November 21, 2025

One girl $75 / $75 / $75

Two Girls $150 / $125 / $125

Three Girls $200 / $200 / $200

Cheques should be made payable to "Challenge Milton" OR e-transfer to challengeinmilton@gmail.com

Email: challengeinmilton@gmail.com

Website: www.regnumchristiontario.org/ecyd

How many children are you registering? (must be siblings)*

123

1st Child's Full Name*

First NameLast Name

Date of birth*

Date

Age*

School Name*

Other School Name

Please indicate School Name

Grade*

Allergies/Medical Issues*

T-shirt size*

2nd Child's Full Name*

First NameLast Name

Date of birth*

Date

Age*

School Name*

Other School Name

Please indicate School Name

Grade*

Allergies/Medical Issues*

T-shirt size*

3rd Child's Full Name*

First NameLast Name

Date of birth*

Date

Age*

School Name*

Other School Name

Please indicate School Name

Grade*

Allergies/Medical Issues*

T-shirt size*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

I understand and agree that the success of the Challenge program for my daughter, depends on every mother’s active participation and commitment. Therefore, I agree to volunteer and participate in weekly meetings at least 1 Friday / month.*

Yes

NATURE OF ACTIVITIES: Formation in Catholic faith and virtue combined with apostolic projects, online activities, recreational activities.

ACTIVITY SUPERVISOR (S): Adult Volunteer Staff of the club/program.

TRANSPORTATION: Not Applicable. Participants are responsible for securing their own transportation to and from activities, as the Challenge Milton does not provide transportation.

REQUIREMENTS: The child named above is in good health and has no physical or medical limitations that would cause the activities as described above to be detrimental or dangerous to the child. Parents/guardians should specify allergies and medical problems in corresponding section.

CONSENT: I/We hereby consent to the above-named child’s participation in the activities described above, and specifically request that he be allowed to participate in those activities. I/We warrant that I/We have full authority to legally consent to her participation in the activities described on this form, and all provisions contained herein.

AUTHORIZATION. I/We hereby authorize Challenge Milton to use the image and likeness of my/our child in photograph or video form whether taken by or commissioned by Challenge Milton. in its promotional materials and for its promotional purposes associated with its nonprofit activities. This authorization shall extend to use of my/our child’s image and likeness on the website of Challenge Milton. or its successor in operation or affiliated organization(s) upon written consent of Challenge Milton. I/We understand that this authorization shall survive the end of my/our child’s participation in the activities referenced on this form.

INSURANCE: I/We understand that Challenge Milton does not carry any health insurance relative to the activities or for any injury that may occur to the above-named child. I/We represent that the child is (a) covered by insurance through my/our own insurance carrier; or (b) that I/We am/are personally financially responsible for any and all medical costs incurred as a result of the child’s injury.

EMERGENCIES: If the above-named child requires any emergency medical procedures or treatments during the activities, I/We consent to the activity supervisor(s) taking, arranging for or consenting to such procedures or treatments in the discretion of the activity supervisor(s). For purposes of such procedures and treatments, my/our child’s blood type allergies or other medical problems (if any) are listed in corresponding section.

EMERGENCY CONTACTS: If, in the event of a medical or other emergency, I/We am/are unable to be reached by telephone at the numbers listed below, I/We authorize the activity supervisor(s) to attempt to contact me/us through the alternative emergency contacts listed below.

Emergency Contact 1 (non-signing parent or other)*

NamePhone Number

Relationship

Emergency Contact 2 (non-signing parent or other)

NamePhone Number

Relationship

RELEASE AND INDEMNIFICATION: I/We release and waive, and further agree to indemnify, hold harmless or reimburse Challenge Milton the individual members, agents, directors, officers, employees, volunteers and representatives thereof, as well as activity supervisors, from and against, any claim which I, any other parent or guardian, any sibling, the above-named child, or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses (including attorneys’ fees incurred by Challenge Milton or any of its individual employees, agents, volunteers, etc. in enforcing this indemnity provision) without limitation in time or amount, damages or injuries arising out of, during, or in connection with my/our child's participation in the activities, the travel to and there from, and the rendering of emergency medical procedures or treatment, if any. I/We understand that this release and indemnification shall survive the end of my/our child’s participation in the activities referenced on this form.

EMAIL COMMUNICATION: Parent's email addresses will be used for Challenge Milton Club and ECYD Ontario communication purposes.

I/We have read and understand the above and agree to all terms and conditions contained therein.*

Yes

Signing Parent/Guardian *

Full NamePhone Number

Signing Parent2/Guardian2

Full NamePhone Number

Date of permission*

Email Address 1*

Email Address 2

Signature*