Day Camp Registration Form

SRC Summer Program Registration

We are excited to provide programming for the summer months, please fill out the information below and select the program for your child to register. Drop ins are always welcome! Registering in advance helps us out with planning. ALL programs and events are FREE!
Camper's Information

Personal & Health & Contact
Child's Name

First NameLast Name
Birth Date

MonthDayYear
Age (at time of camp)
Grade (entering this fall)
List Any Allergies and Dietary Restrictions
Parent / Guardian Information
Name*

First NameLast Name
Email*
example@example.com
Cell Phone*

Area CodePhone Number
Work Phone

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship to the Camper
Emergency Contacts and Authorized Pick Up Persons*
Does your child have permission to walk home alone?*

YESNO
Elementary Summer Program Sign Up Kindergarten - Grade 6

Please select the weeks you would like your child to attend the summer program. You may select mornings, afternoons or full days. For full days please pack a bag lunch, water bottle, and change of clothes if needed. We will post themes as they are finalized. Each week has one special guest at the end of the week.
Week 1 Wilderness Week July 7 - July 11 - Special Guest - NW25 Outdoor Learning Co.
Week 2 Building /Inventions Week July 14 - July 18
Week 3 Sports Week July 21 - July 25
Week 4 Science Week - July 28 - Aug. 1 - Special Guest - The Regina Science Centre
Week 5 Aug. 5 - Aug. 8
Week 6 Aug. 11 - Aug. 15
Week 7 - Music Week - August 18 - August 22 - Special Guest - Mrs. Diane Jones
Learn and Play Pre-K Summer Program

Parents are required to attend this program with their child. This program will run weekly on Wednesdays throughout the summer.
Please check to register.

Pre-K Summer Program (Once a week on Wednesdays from 10:30 a.m. - 12:00 p.m.)
Youth Nights - Grades 7 - 12

Youth nights will run from 6:00 - 9:00 p.m. for four Friday nights this summer! A meal is always included. This night offers board games, activities, art, video games, and more!
Please check the youth night dates you would like to register your child for.

July 10July 24July 31August 14
Waiver and Release of Liability
Springside Community Resource Centre, its staff and volunteers, will take reasonable steps to provide supervision and any necessary equipment so your child can participate in activities, we now remind you that these activities are not without risk. Certain risk cannot be eliminated due to the nature of the activities offered. The elements that contribute to the character of the event can be cause of loss or damage to your property, accidental injury, or illness, or in extreme cases, permanent trauma, or death. We do not want to frighten you or reduce your enthusiasm for these activities, but we do think it is important to be informed and know in advance about inherent risks.

I, the undersigned, give permission for the participant named above to participate in the activities that occur during the Springside Community Resource Centre (SCRC) Summer Program in July and August of 2025. These activities include, but are not limited to, games, crafts, sports, and walking to special activities. I, on behalf of myself, my heirs, my assigns and my estate agree to release and hold harmless SCRC and SCU Partnership, their officers, Board, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (“Releases”), with respect to any and all injury, disability, death, or loss or damage to person or property, whether caused by the negligence of the releasees or otherwise, related to the participant named above in any activity occurring at the Summer Program. Should the SCRC, SCU Partnership, or anyone acting on their behalf, be required to incur attorneys’ fees and cost to enforce this agreement, I agree to indemnify and hold the SCRC and SCU Partnership harmless for all such fees and costs.

In the unlikely event that the participant named above is injured or becomes seriously ill while with the SCRC and I (the parent/guardian) cannot be reached, I authorize the leaders of SCRC Summer Program to seek and authorize medical attention deemed advisable by the circumstances.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Date*

MonthDayYear
Date
Signature*

Clear
Media Release

This is optional and at the parent/guardian's discretion for the use of media of the child.
I grant the release to SCRC the right to use photographs and or videos in which my child appears for use in publicity brochures, newsletters, newspapers and SCRC social media etc. Photos/videos will be non-identifying (i.e. names will not accompany photos).
Date

MonthDayYear
Date
Signature

Clear
Should be Empty:

SRC Summer Program Registration

Camper's Information

Parent / Guardian Information

Elementary Summer Program Sign Up Kindergarten - Grade 6

Learn and Play Pre-K Summer Program

Youth Nights - Grades 7 - 12

Waiver and Release of Liability

Media Release