Required fields are marked with asterisks (*)

Summer 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

Camp information

Please select which camps your child will attend each week. Select N/A if they will not be attending a camp.

Contact information

Parent/Guardian (1) full name

Phone number

Alt. phone number

Parent/Guardian (2) full name

Phone number

Alt. phone number

Emergency contact full 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 flotation 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 flotation device) while swimming during day camp.

Yes

N/A (Campers in Kinder Camp, Little Athletes, Counsellor in Training or any Junior Camp do not swim)

Sunscreen

It is very important to ensure all campers wear sunscreen when outside. Please send sunscreen to camp each day. Due to allergies, we do not permit children from different families to share their sunscreen. Please note that all participants must bring a hat and sunscreen with them to camp each day.

I give permission for the counsellors to assist my child with the application of sunscreen.

Yes

Please list any allergies, dietary restrictions or medical needs

If your child will need additional staff support while attending a Clarington Camp, please fill out the Inclusion Support Request Form.

Please list any special needs

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

Authorization statement

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.

Personal information on this form is collected under the authority of the Municipal Act, 2001 and will be used for the purpose of camp registration. Questions about the collection of this information should be directed to the City Clerk or Deputy-Clerk at foi@clarington.net.

Date