PROOF

Student Information 1

Student Name

First

Last

Which camps would you like to register for STUDENT 1?

July 8 - 12: Art (Painting + Drawing)

July 15 - 19: Build, Create, Make (Woodcraft + Cooking, etc)

July 22 -26, July 29 - Aug 2: Storytelling, Film, Media and Web Design (Attending 2 Week Planned Program)

Only one week of media campOnly one week of media camp

Aug 6 - 9: Soccer

Aug 12 - 16: Fashion Design (with team from John Fluevog)

See fee information below.

Student's Email

Student's Phone (not home phone)

Age *

Birthday

Grade Level Fall 2019 *

School *

Medical Information Student 1

Medical Information (Any Allergies) *

Yes

Does your child have any allergies?

Please list any allergies or food allergies.

Our policy it to provide a safe place for young people. If your child requires medication or epipen, please include instructions and if needed a doctor's note.

MSP NUMBER

Please list your child's MSP and name on their MSP card.

Storage of Medication

I am responsible to have medication packed with my child's belonging everyday.

My child's allergy requires an emergency epipen, I would like to have this stored on premise with your staff for the week.

Are you registering for more than 1 child/student? You can do so below up to 2 more. Look for "Additional Child Registration 2" and "Additional Child Registration 3"

Additional Child Registration 2

(Please click "^" to expand for STUDENT 2)

Medical Information Student 2

Additional Child Registration 3

(Please click "^" to expand for STUDENT 3)

Medical Information Student 3

Parent/Guardian Information

Parent or Guardian Name

First

Last

Relationship to Student: *

Father

Mother

OtherOther

Contact Email *

Home Phone *

Parent Mailing Address *

City *

Province *

Postal Code *

If your child's (children's) mailing address is different, please give us his/her/their information.

Our camp staff may send an encouraging note to students.

DROP OFF | PICK UP | EMERGENCY CONTACT

Emergency Contact Name and Cell Phone *

EG. Janice Doe, Phone:604-980-XXXX

Secondary Emergency Contact Name and Cell Phone *

Drop off and Pick Up *

I or designated guardian will pick up my child (children).

I will need assistance walking my child (children) home.*

*For families that are within walking distance to 558 Powell Street

Please list pick up guardian(s) name(s), their relationship to child, and their cell numbers:

Safety is our policy. If there is a change in pick up, please contact our office as soon as possible. EJ John Doe, Uncle Phone: 778-677-XXXX

LIABILITY + MEDIA WAIVER

I hereby grant or deny (as marked by my selection below) to and for PROMISE VANCOUVER | URBAN PROMISE MINISTRIES to use images of my child / children as the owner of PROMISE VANCOUVER | URBAN PROMISE MINISTRIES determines, such use to include the taking, recording, photographing, display, distribution, publication, transmission, or other uses of photographs, video recordings, digital records and other images taken or made during the course of my child/children’s activities at or with PROMISE VANCOUVER | URBAN PROMISE MINISTRIES. Such uses may include, but are not limited to, advertising and promotional materials, brochures, newsletters and electronic media including the PROMISE VANCOUVER | URBAN PROMISE MINISTRIES website.
*

YES, I grant permission to use my child/children’s image(s) in the following way:

Unrestricted usage: I give unrestricted permission for my child/children’s image to be used in print, video, and digital media. I agree that these images may be used by PROMISE VANCOUVER | URBAN PROMISE MINISTRIES for a variety of purposes and that these images may be used without further notification.

I withhold permission to use my child/children’s image(s).

NOTE: Your child/children will not be included in the highlights video, slideshow, or photo of the camp week that we will be giving students a copy of.

I hereby waive all present and future claims for any loss, damage, or personal injury sustained by the above mentioned student(s) (hereinafter referred to as “the student(s)”) including but not limited to, physical injury sustained by the student(s) during classes, excursions, or activities during our program and camps.

I further release, remise and completely discharge the promoters, directors, principals, volunteers, and employees of PROMISE VANCOUVER | URBANPROMISE MINISTRIES or any competition or performance attended by PROMISE VANCOUVER | URBANPROMISE MINISTRIES from any and all liability whatsoever for any injury or loss caused as a direct result of any act or omission by any of them.

I hereby acknowledge and agree to all of the terms and conditions set out in this registration package, our code of conduct for camps.

*

Yes

SIGNED FORM: I am printing off a physical copy of the Liability + Media form and understand all legal guardians must sign this. I will bring this in before or on day of camp. I understand I am registering and a confirmation will be sent to me as space is limited. LINK TO FORM BELOW

Both items must be checked off for official registration. We will email you the Liability + Media form if you are unable to download it.

By typing in the names of all parent or guardian names, I acknowledge the above.

You can download the Liability + Media form here from this website page (see below or sidebar) or drop in to Promise Vancouver to get a copy. We will also email you one upon confirmation of registration.

IMPORTANT All legal guardians must sign this form so that your child(ren) can participate in our camp and programs. This form is good for summer through June 2020.

If you are human, leave this field blank.