WAITLIST of Sunday Play Date Registration Form Waiver

Supervision of Your Child/Children Acknowledgement and Parental Information Form

Your supervision and attention are required for your child’s/children’s safety. Our Drop-in staff will provide activities so that you can be engaged and interact with your child and/or children in your care. Please complete the form below and list all the health and medical concerns regarding yourself and your child/children.

Please complete the form below and list all the health and medical conerns regarding yourself and your child/children.

Parent/Guardian Name*

First NameLast Name

Parent/Guardian Medical or Health concerns/ Food Restrictions/ Accommodation*

Please also indicate your unit number

I am a UFH resident of:*

UFH Address*

Please also indicate your unit number

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

List the names and contacts of people who have your consent to take care of your child/children in case of an emergency (please list someone other than yourself).*

First NameLast Name

Phone Number of Emergency Contact Person*

Please enter a valid phone number.

Child#1: I am responsible for the supervision of the child in my care listed*

Child's First NameChild's Last Name

Date of Birth*

Date

Age*

Medical or Health concerns/ Food Restrictions/ Accommodation for Child #1*

Child#2: I am responsible for the supervision of the child in my care listed

Child's First NameChild's Last Name

Date of Birth

Date

Age

Medical or Health concerns/ Food Restrictions/ Accommodation for Child #2

Child#3: I am responsible for the supervision of the child in my care listed

Child's First NameChild's Last Name

Date of Birth

Date

Age

Medical or Health concerns/ Food Restrictions/ Accommodation for Child #3

Your moving out month and year? When is your lease finished? *

Do you give permission for UFH to take pictures while in Drop-In Centre programming and have scanned the QR Code for Photo Consent Form*

If yes please ask Staff for QR code to complete form

Risk Acknowledgement (Drop-In Family Program)

Event/Activity/Program at the location: Drop-in Room, Activity Room, or Rooftop Garden

Drop-in Waiver Form: MUST be signed by a parent or a legal guardian of any child participating in specially organized programs arranged by Residence Life Office at University Family Housing. Children are to always be supervised and accompanied by an adult during our program. Under no circumstances may a child be left unattended. Should a child's caregiver need to step out of the room, even briefly, they must take their child with them.

Device-Free Program. Please respect our shared space: to ensure a safe and comfortable environment, we kindly ask everyone not bring laptops or tablets and to minimize mobile phone use for photos or video calls during the program. We request that when posting photos or videos on social media, you only post images of your child(ren) that are not involved other children and others.

I understand that University Family Housing (herein referred to as ‘Family Housing’, or ‘Student Family Housing’) and its representatives will take all reasonable steps to provide care and safety for each family, but I am aware that the GOVERNING COUNCIL OF THE UNIVERSITY OF TORONTO, its officers, employees, agents and volunteers cannot assume responsibility for any injury, loss, damage or harm to any participant or to their property during the course of any activity which is part of the above event, program or trip, including travelling to or from the Family Housing premises.

University Family Housing will use all reasonable efforts in arranging these activities but will not be responsible for any delays, substitutions, and equipment or facilities, mechanical defects or failures during the course of the event, program, trip or activity, however caused. University Family Housing reserves the right to reschedule any activity, should undesirable conditions prohibit travel, in which event University Family Housing will refund any or all payments net of any non-refundable charges incurred by University Family Housing in arranging the trip.

I understand and acknowledge that certain risks of injury, loss, damage or harm inherent to participation in any event, program, trip or activity, and I agree to indemnify and save the harmless THE GOVERNING COUNCIL OF THE UNIVERSITY OF TORONTO, its officers, employees, agents and volunteers from and against any injury, loss, damage or harm that may befall myself or my child or children in my care as a result of their participation in any activity.

I hereby authorize any necessary medical treatment for myself or my child or children in my care by qualified medical practitioners in the event of illness or injury sustained in my absence while they are participating in the event, program, trip, or activity. I declare that I have disclosed any special dietary, allergy, care, or health issues concerning myself or my child or children in my care to University Family Housing.

I am aware that it is each participant’s responsibility to ensure that they have adequate health coverage and medical or disability insurance. University Family Housing does not provide any health or accidental coverage.

BY SIGNING THIS ELECTRONIC FORM: I DECLARE THAT I HAVE READ AND UNDERSTOOD THE ABOVE CONDITIONS AND I HEREBY CONSENT TO BOTH MYSELF, MY FAMILY MEMBER AND/OR MY CHILD/CHILDREN IN MY CARE PARTICIPATING ON THIS AGREED BASIS.

Sign Date*

Date

Signature*

Please read the acknowledgement carefully and sign the form prior to your submission

WAITLIST: Sunday Play Date Registration Form Waiver

Risk Acknowledgement (Drop-In Family Program)