PROGRAMS (Grade 5-7) January 9, 2017 to June 24, 2017

I ______________ give permission for _____________________ participate in the following Ray-Cam Centre programs:

Please INITIAL the PROGRAMS this consent is valid for:

After School Programs
After School All Stars     ( 82016 ) Monday – Friday 3:30 – 5:00 pm
More Sports (82274) Wednesday 04:00 – 5:00 pm
Saturday Pre – Teen  (82055) Saturday 12:00 – 4:00 pm
Kid Power (82046) Sunday 12:30 – 3:30 pm
Spring Day camp (82272) March 15th — April 24th 2017
Judo (82273) March 29th — April 19th 2017
Evening Program
Food Network (82037) Tuesday 6:30 – 9:00 pm
Wednesday Activity (82276) Wednesday 6:30 – 8:30 pm
Soccer (82064) Wednesday 6:30 – 7:30 pm
Girls Space (82040) Wednesday 6:30 – 9:00 pm
Boys Club  (82040) Thursday 6:30 – 9:00 pm
Pre – Teen Night (82054) Monday 6:30 – 9:00 pm

Alternate people who are AUTHORIZED to pick up my child from the program (should be available during the day):

  1. Name:                                                    Relationship:                                           Phone:
  2.  Name:                                                   Relationship:                                           Phone:
I would like to be contact every time my child doesn’t show up to program:  ( ) YES  ( ) NO
My child has permission to return home alone after the program:  ( ) YES  ( ) NO
My child has permission to be photographed during the program:  ( ) YES  ( ) NO
Does your child require extra support during the program :  ( ) YES  ( ) NO
My child has permission to be face painted:  ( ) YES  ( ) NO
Swimming Ability:  ( ) Good  ( ) Fair  ( ) None

Is there any other information which will help your child have a successful program experience?

_________________________________________________________________
Any concerns or restrictions on activities staff should be aware of (ie. face painting, make-up day)

_________________________________________________________________

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CHILD ACTIVITIES (refers to less than 19 years of age)

PARENT/GUARDIAN CONSENT, ACKNOWLEDGEMENT OF RISK, WAIVER, RELEASE & INDEMNITY

NOTICE TO PARENT/GUARDIAN

It is a condition to the Child’s participation in the Activity that you, the undersigned Parent/Guardian of the Child, must carefully read and understand this document and sign it to acknowledge that you have read and understand it and that you understand that the Child’s participation in the activity will expose the Child to risks of harm and that you accept full responsibility for exposing the Child to such risks.

PARENT/GUARDIAN RESPONSIBILITY FOR CHILD

I, the undersigned Parent/Guardian of the Child, understand and accept that, in respect of the Child’s participation in the Activity, it is my responsibility:-
(1) to ensure that I consider and understand the risks, dangers, hazards and consequences of injury inherent in the Activity,

(2) to determine, taking into consideration those risks and the Child’s behavioral characteristics, physical health and abilities, whether the Child should be allowed to participate in the Activity,

(3) to ensure that the Child is appropriately covered by medical insurance for any harm occurring in the Activity, and

(4) to provide emergency medical information regarding the Child as required in this document.

AWARE OF RISKS

I AM AWARE OF AND NOW FREELY ACCEPT AND ASSUME RESPONSIBILITY FOR ALL RISKS TO THE CHILD IN CONNECTION WITH HIS OR HER PARTICIPATION IN THE ACTIVITY, INCLUDING AS FOLLOWS:

(1) the Child’s participation in the Activity, even if the Child possesses behavioral characteristics, physical health and abilities appropriate for the Activity, poses risks of harm to the Child;

(2) the nature of the Activity is such that the Community Centre cannot identify all risks associated with the Activity and cannot guarantee that Community Centre staff participating in the Activity will not make errors therein or that other children participating in the activities will not cause injuries therein others that staff can or might be able to prevent.

I, THE UNDERSIGNED PARENT/GUARDIAN, AM THE PARENT AND/OR LEGAL GUARDIAN OF THE CHILD AND I HEREBY CONSENT TO HIM OR HER PARTICIPATING IN THE ACTIVITY, AND, IN RETURN FOR THE COMMUNITY CENTRE ALLOWING THE CHILD TO PARTICIPATE IN THE ACTIVITY:

  • I NOW WAIVE ALL LEGAL RIGHTS TO SUE AND ANY AND ALL CLAIMS which I or my successors and assigns may have against the Community Centre in connection with any loss, injury, damage or expense that I or the Child may suffer, incur or may suffer, incur or experience in connection with the Child’s participation in the Activity; and
  • I HEREBY RELEASE the Community Centre from any and all liability for any complaints, demands, claims, actions, suits, judgments and orders for any and all losses, injuries, damage of expenses \ or the Child may suffer, incur or experience in connection with the Child’s participation in the Activity; and
  • I AGREE TO INDEMNIFY the Community Centre for and hold it harmless from any and all losses, injuries, damages and expenses of any kind that the Community Centre may suffer, incur or experience and for any and all complaints, demands, claims, actions, suits, judgments and orders for any and all losses, injuries, damages or expenses of any kind anyone else may suffer, incur or experience in connection with the Child’s participation in the Activity.

You can download consent form from link below :-
Consent form Grade 5-7