The following information is necessary for the Boys & Girls Club of London (BGCL) records and statistical information for our funders.

All fields marked with * are required.

Day Camp Rates

Lunch and snacks included.

Note: Week 1 & 6 are 4 days long. All other weeks are 5 days.

5 Day Week	$225
4 Day Week	$190

Extended Care

	5 Day Week	4 Day Week
Early Drop Off	$15 per week	$12 per week
Late Pickup	$15 per week	$12 per week

Check camp availability below by picking the weeks you would like to register for:

Parent / Guardian #1

Parent / Guardian #2

EMERGENCY CONTACTS: These will be the people who are allowed to pick up your child or who will be called if a parent/ guardian cannot be reach in an emergency. These MUST be different contacts than Parents/ Guardians.

 

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Will anyone else other than those listed above be picking up your child? If Yes, please fill out the following

List anyone who is NOT ALLOWED to pick up your child

PLEASE NOTE: Everyone picking up children will be ask to show photo identification. Please ensure that all people picking up your child are aware of this.

*All children are required to complete a swim test*

Special Needs

If your child requires additional support, please contact the Inclusion Coordinator at 519-434-9114 to ensure availability and set up an intake session to assess your child's needs.

A Supplementary Form is also required with registration and each child may register for two weeks
maximum allowing opportunities for others. The form is available on website or at registration booth.

Allergies

Please note: We are not able to accommodate special diet requests, if your child has special diet requirements please provide their lunch.

Administration of Medication

For children that need medication administered during camp, a parent or guardian must:
1. Provide medication in its ORIGINAL CONTAINER to the Camp Coordinator or Camp Director.

We will not accept any form of medication that is not properly labeled or packaged, i.e. in a Ziploc bag.

2. Pick up any remaining medication and packaging every Friday.

3. Inform the Coordinator of Epi-pens and Inhalers - child must keep it but the counsellors are to be made aware of its location.

4. Inform the Coordinator of any changes regarding medication as it may affect the child's performance at camp.

SUMMER CAMP POLICIES

Age Policy The camper's age the week they are attending camp is their registered age.

Children with Difficult Behaviour at Camp

Parents will receive a Behaviour Management Form, signed by Camp Coordinators and Management, to assist their child in dealing with any difficult behaviour experienced at camp. If your child needs to leave camp for not correcting inappropriate behaviour, a refund will not be issued.

Head Lice

If lice is detected on any participant, we will notify parents. Child must be picked up by an authorized person immediately.

Sun Screen

It is our policy to allow staff to assist participants with the application of sun screen provided the following has been completed.

Payment of Fees

Full payment must be received at the time of registration.

Registration Deposit / Changes of Weeks / Camp & Refund Policy

All changes and cancellations must be submitted in writing at least one week prior to the campers start date & $15 Administration fee will be charged for Cancellations or Changes per child per cancellation notice. Other cancellation fees may also apply.

AUTHORIZATION - Registration will not be processed without agreement to the statement below.

In registering the child named in this form to attend BGCL Camp, I, the undersigned parent/guardian or other duly authorized party, hereby agree as follows:

1. To permit my child to participate in the full range of BGCL Camp activities and authorize the BGCL Camp Staff, in the event of accident, injury or illness affecting the above named camper to authorize on my behalf all medical and other procedures, including admission to hospital and all other necessary treatment, as he/she may seem essential for the care and well-being of the said camper. Such action is to be taken only when immediate contact with the undersigned cannot be made.

2. I understand that camp activities have an inherent risk factor and that all appropriate precautions will be taken for participant safety. I agree to not hold the Boys & Girls Club of London or any of it's employees responsible in the event of an injury to my child.

3. I understand and agree to the Boys & Girls Club of London's Summer Camp Policies stated above.

PLEASE NOTE: Promotional Material: The BGCL reserve the right and permission to publish, reproduce, distribute and /or otherwise use any still or moving photograph, for such purposes and with such frequency as it shall determine in its sole discretion without further compensation or consideration to me and without further authorization by me for, as yet, unnamed video or photographic projects (including promotion, marketing and social media) which shall constitute the sole property of the BGCL. The BGCL shall be released from and against any and all liability resulting from its use of the photos or related to my use of the product.

General Waiver: I, the undersigned, the parent/guardian of the above named child do hereby consent to this child's participation in the Boys & Girls Club of London's programs. I acknowledge that participation in these programs involves light to vigorous activity and includes the possibility of injury. I grant program officials the authority to obtain emergency medical treatment as necessary to ensure that the above named child is safe from further injury. I am aware of no physical or other reasons why this child should not participate in club programs and related club functions.

The risk of sustaining injuries results from the nature of the activity and can occur without any fault of either the Member, or the Club, its employees/agents or the facility where the activity is taking place.
By choosing to take part in this activity, I am accepting the risk that my child may be injured. The Boys and Girls Club of London does not provide accidental death, disability, dismemberment or medical expense insurance on behalf of the participants in this activity. In consideration of the Boys & Girls Club of London allowing this child to participate in club programs, I agree to waive and release Boys & Girls Club of London, its employees, volunteers, directors and agents (the “Releasees”) from all claims for damages, injury or loss that may arise as a result of my child's participation in programs, including those arising from the Releasees own negligence (i.e a failure to take reasonable care). I will impress upon the child the importance of following club rules, regulations and instructors directions.