Summer Camp Detailed Registration Form

OLIVER COMMUNITY ARTS COUNCIL

SUMMER 2025
Art AdVenture Oliver Program Registration & Waiver

*One is required for each day booked, as each class is scheduled as an independent event or program.*
Participant's Information
Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
Age*
Age is required to ensure your child is in the right program
Gender

MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
Is the Child prescribed an EpiPen? If yes YES 1 NO 2 , please explain for what allergy and any instructions BELOW IN DETAILS PLEASE.
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe. Is any medications administered please advise for emergency purposes only.
Is the child prescribed an inhaler? If yes, please explain any instructions.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Oliver Community Arts Council & their representitives during the selected program that I am selecting. In exchange for the acceptance of said child’s candidacy by Oliver Community Arts Council, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Oliver Community Arts Council and all their representitives, volunteers and anyone else supporting these programs and its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected programs or while on site.

In case of injury to said child, I hereby waive all claims against Oliver Community Arts Council, including all representitves, instructors, support personal and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, board directors and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all activities, including some arts and crafts. Some of these injuries include, but are not limited to, the risk of cuts, sprains, brusing, or anything severe such as paralysis and death from unknown accidents or incidents.
Medical Release and Authorization

As Parent and/or Guardian of the named child, 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 treatment for the named child. 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 the Oliver Community Arts Council and its affiliates including Directors, Instructors, and Team Supports or partners to provide the needed emergency treatment prior to the child’s admission to the 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 ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
Date
Signature

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Date that you would like your child to attend the program?*

MonthDayYear
Date

OLIVER COMMUNITY ARTS COUNCIL

Art AdVenture Oliver Program Registration & Waiver

Participant's Information

PROGRAM DETAILS PER DAY