ICAC Fall 2026 PA Day Camp Registration Form

Please note, the ICAC's October 26 PA Day Camp has now reached full registration.  Any registration forms submitted will be added to our waitlist.  Thank you!

Emergency Contact: In the event the parent/caregiver(s) cannot be reached, please list additional contacts.

Sign-In/Out: Please list ALL people authorized to sign your child in and out of day camp. Please note that individuals listed will be required to show photo ID at time of pick up.

Medication (including Epi-pens) must be submitted to our office in its original prescribed bottle with child's name. The medication administration chart above must match the prescription label.

Waiver (Please read carefully): I permit my child to participate in all activities offered in the program. In the event of an accident or illness affecting my child, I consent to have the Ingersoll Creative Arts Centre staff authorize any necessary procedures, including admission to the hospital, as may be deemed essential for the care and well-being of the participant. Such action is to be taken only when immediate contact with the parent/guardian or emergency contact(s) cannot be made. I understand that, to be eligible for a refund (minus a $10 administration fee), 2 weeks notice will be required to cancel care. I have read, understand, and accept the Ingersoll Creative Arts Camp Program’s policies as described in this waiver, and I have read and understand all information in the provided information packet.