Contact information

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Contact information

Grange Hill East NG PA Day Camp June 7th 2019
Location: 394 Auden Road
Cost:$25.00
Before Care (8:00-9:00am) $5
After Care (4:00-5:00pm) $5

Camper's Name *

Camper's Age *

Parent/Guardian's Name *

Email *

Address *

Phone number *

Emergency Contact *

Custody Arrangements (if applicable)

Allergies/Medical Conditions

If your child must take medication while at this event/program, please indicate information:

Behaviour/Communication (any strategies or methods that would help your child succeed at this event/program):

I understand that the Grange Hill East Neighbourhood Group Staff reserve the right to dismiss a participant who, in their opinion, is a hazard to the safety or rights of others, or who appears to have rejected the reasonable expectations of the program *

I agree

Required

To the best of my knowledge my child is in good health. If there is any exposure to any infectious disease and/or change in my child’s condition prior to attending program, I will notify the office staff immediately *

I agree

Required

I agree to indemnify (insure against loss) Grange Hill East Neighbourhood Group, the Guelph Neighbourhood Support Coalition and their agents, employees, members, directors and officers for any kind of liability, howsoever incurred or caused during the stay of the members listed below on or off site. *

I agree

Required

I further agree and understand that the Grange Hill East Neighbourhood Group, The Neighbourhood Support Coalition and their agents, employees, members, directors and officers shall not be responsible or liable for: any loss or damage of any kind to the property whatsoever however caused; and any injury to any person however caused

I agree

I give permission for my child to go off-site to areas within walking distance during this event/program (ie. local park, etc.) *

Yes

I give permission for photographs and videos of my child to be used for promotional purposed by Grange Hill East Neighbourhood Group and/or the Guelph Neighbourhood Support Coalition

Yes

Clear selection

Before Care & After Care are available. $5 8-9am /$5 4-5pm.

Before Care Required $5

After Care Required $5

Clear selection

Payment ($25 per camper) Payment must be received before June 7th 2019 *

Drop off cheque or cash

e transfer to treasurer@gheng.ca or info@gheng.ca (Please include child's name and 'June PA Day camp' in message)

Parent Signature/ Date *

Submit

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