Camp eX 2019 Registration Form

Camp eX 2019 Registration Form

Welcome to The Exhibition Park Neighbourhood Group's on-line camp registration!
Thank you for your interest in the EPNG's Camp eX!

Camp fees are $120/week, per camper.

Time: 9:00AM - 4:00PM-4:15PM
Drop Off: 8:30AM (no charge)
Extended Hours for Pick Up: 4:15PM-5:00PM ($5.00/day, per child)

Once your registration is received, an EPNG volunteer will confirm back within 24 hours if they were able to secure a spot for your camper. All spots will be confirmed in order of receipt through this on-line program. Prority will be given to siblings as long as the forms are submitted in a reasonable timeframe. Those we are not able to accommodate right away will be automatically placed on a waitlist.

Once we have confirmed your spot, you will receive instructions for payment. Payment is due in full within 24 hours.

One last thing - The EPNG is run solely by volunteers and we appreciate your patience and support. Any feedback is welcome!

Your neighbours,

The EPNG Camp Team
campex2019@gmail.com
Week 1 Only (August 12th - August 16th)Week 2 Only (August 19th - August 25th)Both Weeks
Camper Information
Name of Camper*

First NameLast Name
Date of Birth*

MonthDayYear
Gender
Parent / Guardian Information

If more than one parent / guardian will be picking the child up from camp, please fill in both sections. If parents / guardians live at the same address, the address only needs to be filled in once.
Parent / Guardian 1*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Alternate Phone Number

Area CodePhone Number
E-mail*
Parent / Guardian 2

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Alternate Phone Number

Area CodePhone Number
E-mail
Emergency Contact Information

Please note that the Emergency Contact must be someone other than the participant's parent(s) or legal guardian(s). In the event of an emergency or program cancellation, the person named below will be contacted only if we have been unable to reach the participant's parent(s) or legal guardian(s).
Name*

First NameLast Name
Relationship to camper*
Phone Number*

Area CodePhone Number
Alternate Phone Number

Area CodePhone Number
Name

First NameLast Name
Relationship to Camper
Phone Number

Area CodePhone Number
Alternate Phone Number

Area CodePhone Number
Arrival / Pick-Up Information
My child has permission to arrive independently to camp and to leave independently after camp*
My child has permission to be picked up by people other than the listed parents / guardians*
If your answer is YES, you must list the names below
Name

First NameLast Name
Name

First NameLast Name
Name

First NameLast Name
Extended Care

Pick-up from 4:15PM-5:00PM is available for $5.00/day, per camper
MondayTuesdayWednesdayThursdayFriday
MondayTuesdayWednesdayThursdayFriday

Medical and Other Information

Please list anything you feel the staff should be aware of to ensure the best possible experience for your child at camp.
YesNo
If YES, please list
List all that apply
YesNo
If YES, please list
YesNo
If YES, please list
YesNo

YesNo

Yes, I understand that fees are not refundable

By hitting SUBMIT on this registration form:

I hereby authorize program staff to administer emergency first-aid and seek medical treatment or hospital care in the event that a serious injury or illness is incurred while under their care and agree to cover any resulting expenses.

I understand that any agents, employees, members, and directors of the Exhibition Park Neighbourhood Group, and the Guelph Neighbourhood Support Coalition are not responsible for the loss or damage of any participant’s personal property nor are they responsible for any injuries incurred during program activities.

I understand that program staff and volunteers are not responsible for my child prior to their arrival at program and after their departure from program.

I understand that all Staff reserve the right to dismiss a participant who, in their opinion, is a hazard to the safety or rights of others, or who appears to have consistently rejected the reasonable behavioural expectations of the program. I also understand all participants are bound to the Code of Conduct, and the steps which Staff will take if behavioural challenges persist.

The personal information on this form is collected and retained in accordance with the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA), for administration of the Exhibition Park Neighbourhood Group programs. At no time will your personal information be disclosed without your express written consent.

The Exhibition Park Neighbourhood Group
I have read and I understand the above
Name of person submitting:

First NameLast Name

Should be Empty:

Camp eX 2019 Registration Form

Camper Information

Parent / Guardian Information

Emergency Contact Information

Arrival / Pick-Up Information

Extended Care

Medical and Other Information