Child Registration For Children in Grades 1-6
(Children must have completed Kindergarten)
July 14 -18 Full Day:
M-TH: 8:30am - 4:00pm, F: 8:30am -11:45am
Half Day:
M-F 8:30am -11:45am
Registration:
Location:
April 5, 2014- June 8, 2014 (Or until capacity is reached.)
Centre Street Church Central Campus 3900 2nd Street NE
Participant info: First Name: __________________Last Name: _________________________ Birth date (dd/mm/yyyy): ______ / _______ / _________________________
As of fall 2014 child is going into:
o Grade 1 o Grade 2 o Grade 3
o Grade 4 o Grade 5 o Grade 6
Address: ________________________________________________________ City: ________________________Postal Code: ________________________ Home Phone: _________________Email: _____________________________ Allergies/Special Needs: __________________________________________
Parent/Guardian info: Name: _____________________ Name: _____________________________ Cell Phone: __________________ Cell Phone: _________________________ Work Phone: _________________Work Phone: ________________________ Email: ______________________ Email: _____________________________ Does parent live with child? ____ Does parent live with child? ___________ Are there any custody concerns? ____________________________________
Emergency Contact (other than parent/guardian): Name: _____________________Daytime Phone: ______________________
Half-Day:
o Half-Day: $50 o Half-Day (Parent volunteering): $30 Choose 1 of these: Crafts ____Science____
Full-Day:
o Full-Day: $140 o Full-Day (Parent volunteering): $80
Choose 1 of these: Crafts____ Science____ Choose 2 of these: Arts/ Crafts ____Sports/Games ____Hands on Science____
Shirt size: (full-day participants only)
o o
Youth 6-8 Youth 10-12
o o
Youth 14-16 Adult S
How did you hear about CSCamp? CSC____ School ____Poster ____Friend ____Website ____
o
Adult M
PICTURE RELEASE FORM
In consideration of the opportunity to assist the Centre Street Church (CSC) and other good and valuable consideration, the receipt and sufficiency of which is acknowledged, I consent and agree to the terms of this Model Release Form ("Release"). No payment or consideration will be paid by CSC or claimed by me. I consent to CSC photographing my child, and publishing and distributing for any legal purpose any and all resulting images ("Images") of my child, including any personal information about my child that may be captured in such Images, for the purposes of making the Images available to members of CSC and the general public, in any media, including but not limited to digital media and the Internet via the CSC website. I grant to CSC a perpetual, worldwide, fully paid, irrevocable and exclusive right and license to use, modify, publish, distribute, license and/or sell, in whole or in part the Images, including all copyrights, for the foregoing purposes. Any rights incapable of being licensed, including moral rights, are irrevocably waived. This does not make me or my child an employee, agent, or partner of CSC. No publication or other material using, involving or related to the images need be submitted to me for any further approval and CSC shall be without liability to me for any use distortion, illusionary effect or adverse result to me on account of the Images. I consent to the use of any reasonable print or textual material in conjunction with any Image. I release, waive, covenant not to sue and forever discharge and hold harmless CSC and its successors and assigns from any and all liability, claims, actions, causes of action and demands of whatever kind or nature, which arise or may hereafter arise out of or in connection with the use of the Images.
INFORMED CONSENT AND WAIVER AGREEMENT:
I, the parent or guardian named on this registration, do herby agree to, and give permission for: A) the children named herein to participate in the Centre Street Church Children’s Ministries program (“the Program”) and assume all risk of loss, expense, damage or injury resulting from their participation in the activities of the Program, and B) do hereby give permission for staff members of Centre Street Church to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant(s). I, the parent or guardian named on this registration, in consideration of Centre Street Church registering the participant(s) in the program, undertake and agree as follows: To waive any and all claims that I have or may have in the future have against Centre Street Church, its staff members, Board of Governors, employees and volunteers, and their agents, representatives, successors and assigns (collectively referred to as the “Releasees”), and to release the Releasees of and from any and all losses, expenses, damages, and claims arising out of or in connection with injury or damage suffered by the participant(s) as a result of participating in the activities of the Program. And to indemnify and hold harmless the releasees from any and all liability for any losses, expenses, damages and claims arising out of or in connection with injuries or damage to any and all persons and to any and all property, in any way sustained or alleged to have been sustained, as a result of the participant(s) engagement in the activities of the Program. This release is effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives, in the event of my death or incapacity. By signing below, I consent to having the information in this document collected by Centre Street Church. This personal information in being collected for the purpose of enrolling your child(ren) in the Program, to assign the child(ren) to the appropriate classes, to develop and nurture ongoing relationships with you and your children(ren) and to inform you of Program updates and upcoming opportunities at our church. Your personal information is protected under the Personal Information Protection Act in the Province of Alberta.
I have read and understood this agreement and I am aware that by signing this agreement I am waiving certain legal rights which I or my heirs, next of kin, executors, administrator, assigns and representatives may have against the Releasees. Signed and dated this ____ day of ________ _____201_____, at Calgary, Alberta. ___________________________ Signature of Parent or Guardian
______________________________ Printed Name of Parent or Guardian
FAQ: Where is CSCamp located?
CSCamp is at CENTRAL CAMPUS-Centre Street Church, 3900 2nd Street NE.
I have a child who has not completed Kindergarten, can they come?
Day camp is for children who are going into grades 1 - 6 this fall 2014. Children must have completed Kindergarten. Preschool Camp (birth –K) will be available in the morning, only for children of parents who are volunteering and who have at least one child registered in grade school camp.
What will the children be doing?
Small groups of children, along with their leaders will spend the morning together doing all kinds of fun activities including: games, science, crafts, singing, and stories! Additionally, full-day children will be going on field trips.
Do you provide lunch for my child?
No, if your child is full-day please send a bag lunch with your child that is nut/peanut free.
Do you accept children with allergies or special needs?
We would LOVE to have your child with allergies or special needs at CSCamp. Please list your child’s special needs on this form and we will contact you to discuss how to give your child the best experience possible. Parents/guardians must provide their own aide should their child need one.
When is the registration fee due?
Registration fee must accompany this completed form. You can drop off your registration form in an envelope marked “CSCamp” along with the registration fees, in cheque or exact cash, to the Central Campus Reception desk upstairs. Please place your envelope in the confidential mail slot located in the reception desk. The registration fee includes snacks, and all activities at CSCamp. The full-day fee includes a t-shirt and 3 afternoon field trips. Registration fees will not be refunded after June 15, 2014. Scholarships may be available by filling out the application form at cscamps.ca and submitting it with this form.
What if I have other questions?
Check out our website, cscamps.ca or contact
[email protected], or call Dorothy Martin @ 403-520-1219
Office use only: Received ___Paid____Cash____Cheque____F1____XL___
