PED DAY Program Fall 2024 Registration Form

PED day Adventures: Program Registration

2024
I would like to register my participant for

PED Day: September 20th, 2024PED Day: October 4th, 2024PED Day: October 18th, 2024PED Day: October 25th, 2024PED Day: November 1st, 2024PED Day: November 22nd, 2024PED Day: December 13th, 2024All PED Days: Sept. 20, Oct. 4th, Oct. 18th, Oct. 25th, Nov.1st, Nov.22nd, Dec.13th

Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Campers Medicare card number and expiration date*
Allergies, chronic illness, or medical conditions? If yes, please describe.*
**A separate camper health form must be filled out prior to the start of camp****Please notify the camp if there are any changes to the camper’s medical history after completing these forms**

Parents agree to release and indemnify 7730616 Canada Association doing business as Trails Recreation Center, owner, director and all other staff from any and all claims for damages arising as a result of any accident, injury or otherwise sustained by the here in named child arising from participation in activities, wherever they may be, either on or off camp property
Campers Name

First NameLast Name
Parent/Guardian Name

First NameLast Name
All parties agree that the language of this contract is in English.
Date

MonthDayYear
Date
Signature of parent or Guardian*

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Les parents acceptent de ne pas engager de poursuites judiciaires contre 7730616 Canada Association, Trails Recreation Center le propriétaire, le directeur et tous les employés, résultant de dommages survenus lors d'un accident quelconque ou d'une blessure subie par l'enfant participant a l'une ou l'autre des activités, qu'elle soit survenue sur les lieux du camp ou a l'extérieur de ceux-ci.
Nom de l'enfant

First NameLast Name
Nom du parent our tutuer

First NameLast Name
Toutes les personnes acceptent que la langue de ce contrat soit en anglais.
Date

MonthDayYear
Date
Signature du parent ou tuteur*

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PED day Adventures: Program Registration