Required fields are marked with asterisks (*)

March Break Camp Information Form

Please note: This is not a registration form.

All campers must be signed in and out each day. Parents/guardians should accompany their child(ren) into and out of the building each day as we cannot be responsible for campers who are dropped off and/or picked up at the door. All persons signing out a child, will be required to show photo ID, and must be listed in advance on this form. Please ensure you include all possibilities (i.e. emergency pick-up by neighbour, grandparent, etc.)

Our camps strive to be nut free. Please do not send your child with any products containing nuts. Clarington camps are not a peanut-free environment. We cannot ensure that all food served in community centres or items brought into camp by other campers do not contain peanuts or other nut traces. If your child has a nut allergy, please let the camp staff know. Campers with nut allergies attend camp at their own risk.

Camp hours and locations:

Regular camp hours are 9 a.m. to 4:30 p.m.

Extended care hours are available at most locations at an additional cost, but participants must be registered in advance for this (7 to 9 a.m. and 4:30 to 6 p.m.).

Should a problem arise, we require this information so we may deal with the problem as quickly and safely as possible to ensure the well-being of your child.

Child's full name

Child's Date of Birth (MM/DD/YYYY)

Child's full Address

Please select which March Break Camp your child is attending.

Kinder Camp – South Courtice Arena

Hockey Camp - South Courtice Arena

Creative Arts Camp - Garnet B. Rickard Recreation Complex

Junior Science Camp - Garnet B. Rickard Recreation Complex

Multi-Sports Camp - Bowmanville Indoor Soccer

Discovery Camp - Diane Hamre Recreation Complex

Contact information

Parent/Guardian (1) name

Phone number

Alt. phone number

Parent/Guardian (2) name

Phone number

Alt. phone number

Emergency contact name - other than Parent/Guardian(s) listed above

Phone number

Alt. phone number

I give my permission for my child to sign themselves in and out of camp daily.

Yes

Swimming information

Please select whether you would like your child to wear a PFD (personal floatation device). By selecting "Yes", your child will not be given the opportunity to attempt the swim test, and will automatically be placed in a PFD and 8:1 ratio with a camp counsellor for the duration of all camp swims.

My child requires a PFD (personal floatation device) while swimming during day camp.

Yes

N/A (Kinder Camp, Junior Science Camp and Hockey Camp participants do not swim)

Please list any allergies or special needs below.

Dress for the weather

Winter campers should come with weather-appropriate outdoor attire, including boots, snows pants, hats and gloves. In addition, please bring clean indoor shoes.

I hereby grant permission for my child’s picture to be taken at camp by municipal staff for camp use.

Yes

Photo release statement

I hereby grant to Municipality of Clarington the right to reproduce, use, exhibit, display, broadcast, distribute and create derivative works of the photographed images of my child(ren), taken at municipal run camps, for use in connection with the activities of the Municipality or for promoting, publicizing or explaining the Municipality and/or its activities. This consent/release includes, without limitation, the right to publish such images in the Municipality’s newsletter, recreation guides, Visitor's Guide and PR/promotional materials, such as marketing publications, advertisements, and any other Municipality-related publication.

I agree to the photo release statement above.

Yes

* If at any time the above information should change please send your child with a signed note clearly indicating the changed information.

Authorization

In permitting my child to attend camp operated by the Municipality of Clarington, I permit my child to participate in all activities and authorize on my behalf all procedures, including admission to hospital and necessary treatment therein, as he/she may deem essential for the care and well-being of said camper.

I agree to waive all claims against the Municipality of Clarington and hold the Municipality, its officers, agents and employees, harmless from any and all liability or claims, which may arise out of or in connection with my child’s participation in this activity.

I fully understand that participants are to abide by all the rules and regulations governing conduct during any off site trips.

Parent/Guardian Signature

Clear

Date (MM/DD/YYYY)

Form Builder

March Break Camp Information Form

Contact information

Swimming information

Photo release statement

Authorization