CAMP ROCK REGISTRATION FORM

CAMP ROCK

KIDS SUMMER CAMP
44 Steinway Blvd., Unit 10
Etobicoke, ON M9W 6Y7
416-213-1818
summercamp.solidrock@gmail.com
Read before Registering:
- Fill out one form for each child.
- Non-refundable Deposit Fee $150

- Campers must be registered for 4 weeks minimum
- There is no daily fee option
- The cost remains the same if a camper is absent
CHILD INFORMATION
Child's Name

First NameLast Name
Date of Birth MMM/DD/YYYY

MonthDayYear
Age
Grade Completed
Gender:
T-shirt size:
Custody:
Mother/Father - Shared: If shared, parents are
First Language
Second Language
PARENT/GUARDIAN INFORMATION
Parent 1

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
City, Prov.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone #1: Cell/Home/Work
Format: (000) 000-0000.
Phone #2: Cell/Home/Work
Format: (000) 000-0000.
Email
example@example.com
Parent 2

First NameLast Name
Same Address as Parent 1
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
City, Prov.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone #1: Cell/Home/Work
Format: (000) 000-0000.
Phone #2: Cell/Home/Work
Format: (000) 000-0000.
Email
example@example.com
HEALTH & EMERGENCY INFORMATION
Health Card Number
Any allergies / special needs
Emergency Contact
Phone Number
Format: (000) 000-0000.
Relationship
AREAS OF INTEREST
Select the areas your child has interest
Other areas of interest
PERMISSION TO PICK UP CHILD
Persons listed in the PARENT/GUARDIAN are expected to pick up their child(ren) from camp. List the names of additional persons who are permitted to pick up your child from camp.
Name

First NameLast Name
Phone 1: Cell/Home/Work
Format: (000) 000-0000.
Phone 2 : Cell/Home/Work
Name

First NameLast Name
Phone 1: Cell/Home/Work
Format: (000) 000-0000.
Phone 2 : Cell/Home/Work
AGREEMENT AND RELEASE WAIVER
All participants must have a registration and waiver form completed and submitted prior to the commencement of the program or activity. This completed form covers all social events and activities of Solid Rock Christian Assembly.
Solid Rock Christian Assembly uses media, sound, slides, CDs, DVDs, photo and video footages from services, programs, special events, activities etc. for promotional purposes on the website or various social media accounts. Participants' photographs or videos may be used in a positive manner.
Waiver of Responsibility, Release of Liability and Assumption of Risk
I consent to my child being a participant in Kingdom Kids Activities, administered at S.R.C.A. I understand he/she will be cared for and supervised accordingly. By allowing their attendance I am aware of potential risks involved, such as accidental bodily harm. In good faith, and support of the Kingdom Kids ongoing programs, I will encourage my child to follow instructions at all times, while engaged in the activity. More importantly, I agree to forfeit the pursuit of liability action against S.R.C.A. instructors, staff and assistants. I waive any claims against S.R.C.A in connection with personal injury, loss or damage that my child may sustain.
Acknowledgement and Permission
I HAVE READ AND UNDERSTOOD THE TERMS OF THIS WAIVER AND AGREE TO ASSUME RESPONSIBILITY TO DO ALL WIHIN MY INFLUENCE TO REDUCE AND ELIMINATE THOSE RISKS. I AGREE TO RELEASE SOLID ROCK CHRISTIAN ASSEMBLY OF ANY LIABILITY AND WAIVE ALL CLAIMS. Please be advised that photos and videos are taken during events and may be used for educational, media and promotional purposes.
Payment/Cancelation/Attendance/Dress Code Policy
1. Deposits and camp fees are non-refundable
2. Campers should be in appropriate camp attire
3. The cost remains the same if a camper is absent
4. Campers must be registered for 4 weeks minimum with payment
Attire needs to be conservative, modest, neat and appropriate; also, it should not be a distraction, express an ungodly lifestyle, nor tempt others to stumble. Parents and students have the primary responsibility to understand and adhere to the dress code. Clothing must fit properly - not too small and not too large, no spaghetti straps, tank tops or halter tops, no tight or sheer clothing that shows skin, stomach, no short shorts (must be knee length), or tight-fitting shorts.
Camp Rock ensures to have committed staff throughout the 8 weeks so that all programs run safely and well.
I give
Child's Full Name
permission to participate in social activities and events hosted by S.R.C.A staff and assistants. I understand and agree to adhere to the policies of S.R.C.A. I also understand and agree that S.R.C.A. has the right to withdraw any participant that does not adhere to the rules and regulations.
Signature of Parent/Guardian
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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Should be Empty:

CAMP ROCK

CHILD INFORMATION

PARENT/GUARDIAN INFORMATION

HEALTH & EMERGENCY INFORMATION

AREAS OF INTEREST

PERMISSION TO PICK UP CHILD

AGREEMENT AND RELEASE WAIVER

Waiver of Responsibility, Release of Liability and Assumption of Risk

Acknowledgement and Permission

Payment/Cancelation/Attendance/Dress Code Policy