Clone of Summer Camp at McKenzie Lake Community Association

McKenzie Lake Community Association is running fun filled and action packed Camps for the duration of the teacher strike.

The camps run from 8am-5pm.

Weekly camp fees are $200 per week, or $40 per day.

Child's Name*

First NameLast Name

Child's Date of Birth*

Date

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Name*

First NameLast Name

Parent/Guardian Email*

example@example.com

Parent/Guardian Number*

Please enter a valid phone number.

Second Parent/Guardian Name

First NameLast Name

Second Parent/Guardian Email

example@example.com

Second Parent/Guardian Phone Number

Please enter a valid phone number.

Parent/Guardian Marital Status

If separated or divorced please provide custody details and a copy of any official papers with court orders on them.

Emergency Contacts (other than parents) with phone numbers. We need to have at least one additional person listed here*

Pick Up List- anyone other than parents allowed to pick up child. These individuals will be asked to provide ID for us to release your child to them*

Anyone NOT allowed to pick up your child*

Child's Doctor:blanks Phone Number: blank

Emergency Authorization: I give permission for McKenzie Lake Community Association BAS Care to obtain medical treatment, including emergency transportation, for my child if I cannot be reached immediately. I agree to be responsible for any emergency medial expenses incurred. *

List and describe any special needs or instructions below:

Activities away from the MLCA building including the aspen forest behind the building, McKenzie Lake School playground, St. John Henry Newman playground and Fish Creek Park (walking to and from these locations).*

YesNo

Walking to and from St. John Henry Newman school. Please see detailed route below.*

YesNo

Please review the following documents for our walking route to and from St. John Henry Newman School and Fish Creek Park.

1.Parental Agreement with McKenzie Lake Community Association Summer Camp Care. McKenzie Lake Community Association BAS Care agrees to provide child care for blanks
2. Before ANY medication is dispensed to the child, parents/ legal guardian will provide a medication authorization form which includes : Name of child, date, name of the medication, prescription number, dosage, date and time of day medication is to be given, and when it was last given at home. Medicine must be in the original container with the child's name marked on it, and not past it's expiry date.
3. McKenzie Lake Community Association BAS Care agrees to keep parents/legal guardians informed of any incidents, including illness, injuries, or adverse reactions to medicines, etc., which include the child.
4.The child will not be authorized to enter or leave the facility without being escorted by the parents, or legal guardian, person authorized by the parent or BAS personnel.
5.Parents/legal guardians acknowledge that it is their responsibility to keep the child's records current to reflect any significant changes that may occur. (ie. telephone numbers, work location, emergency contacts child's physician, child's health status, infant feeding plans and immunization records, etc.)

I, the parent/ legal guardian, have read all the policies and procedures, understand them, and agree to abide by them as they are written.*

Nicknames my child likes to be called:

Does your child have any allergies documented by a physician? Or any foods or medicines that your child has a reaction from?*

Is there anything else we should know about your child or that you would like to share with us?

Child Information*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian phone number*

Please enter a valid phone number.

Parent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Phone Number*

Please enter a valid phone number.

Parent/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact information (in case we can't get a hold of the two people listed above)*

First NameLast Name

Emergency Contact information (in case we can't get a hold of the two people listed above)*

Please enter a valid phone number.

Allergy information*

Immunizations up to date?*

Please attach a current close up face picture of your child in the space below. You must upload a picture to proceed with the registration forms.*

Child Admission Form

Portable Records page