Summer Camp Registration 2019

Please complete this form on a computer or laptop only!

Camper's First Name*

Camper's Last Name*

Camper's Gender*
MaleFemale

Date of Birth*

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Select the session you want to register for*
2 weeks: Jul 14-July 28, Session 1.
2 weeks: Jul 28-Aug 11, Session 2.
1 week: Jul 14-July 21.
1 week: July 21-July 28.
1 week: Jul 28-Aug 4.
1 week: Aug 4-Aug 11.
4 weeks: Jul 14-Aug 11.
other

Select your payment*
2 weeks Refer a Friend: $515*2+$134 HST=$1164
2 weeks: $580*2+$151 HST=$1311
1 week Refer a Friend price $545+$71 HST=$616
1 week $598+$78 HST=$676
4 weeks promo price $490*4+$255 HST=$2215
3 weeks promo price $495*3+$193 HST=$1678

Parent/Guardian Name(s) that will be used on camp receipt*

EXTRA PROGRAMS (Already included in camp fee)

Leadership-in-Action Certification Programs (details: Leadership Program)
-For 13-16 years ONLY. -Attendance of 2 weeks is required
Leadership IntroductionLeadership Advanced ( for those who completed Leadership Introduction

Boot Camp/Weight Management Program (details: Boot Camp Program)
add BootCamp

English Classes (details: English Classes)
add English Classes

Grouping request, if any. I want to be with the following campers:

How did you know about us?*

FAMILIY INFORMATION

First Parent or Guardian

Full Name*

Contact Phone*

Contact Email*

Second Parent or Guardian

Full Name

Contact Phone

Contact Email

Child's Home address

Street Address*

City*

Zip or Postal Code*

Country*

Family Status
MarriedDivorcedSeparatedSingle MotherSingle FatherOther

Custody
JointMotherFatherGrandparent(s)Guardian(s)Other

I give my authorization for over the counter medication*:
Over-the-Counter (OTC) Medication may at times need to be administered, if approval is indicated by the camper's parent or guardian. Camp staff reserves the right to use generic equivalents when available for the name brand over-the-counter medications listed below. I hereby authorize that the following medications may be given to my child, as directed if the need arises: • Pepto Bismol for upset stomach, diarrhea or nausea. • Gravol for nausea. • Loperamide hydrochloride (e.g.Imodium) for diarrhea. • Benadryl, Claritin for swelling, hives, allergic reaction. • Tylenol/Advil. • Ointments for minor wound care, first aid as directed. (Antiseptic, anti-itch, anti-sting, antibiotic). • Throat lozenges and or sore throat spray. • Cough syrup. • Calamine lotion for bug bites, sunburn and poison ivy. • Sunscreen, Bug repellent, After bites. I understand that such administration will not be done under the supervision of medical personnel. I also agree that any first aid treatment may be given as needed. Any condition which is associated with fever, significant inflammation, and/or does not respond to the above outlined treatment will be followed-up by a consultation with the camper’s parents. I shall indemnify and hold harmless the DiscoveryLand Camp Staff against any claims that may arise relating to my child being administered the above indicated over-the-counter medications.

DiscoveryLand Camp Terms and Conditions:
1. Camp cannot be held responsible for lost, damaged or stolen belongings including clothing collected for laundry. Campers should not bring valuables to camp. 2. As the parent/guardian, I hereby consent to the use of my child(ren)’s photos, videos and name for publicity purposes by the Camp. 3. For the safety and enjoyment of all participants during the session, any camper who violates this policy, as listed below, or violates any other serious rule or policy, or any camper who jeopardizes the safety or contentment of others or themselves can be dismissed from camp and parents will have to pick them up. Please note that such dismissal is in the sole discretion of the Camp Director and such camper will not be entitled to a refund. The following are examples of inappropriate behavior: • Verbal or physical abuse of other participants or instructors; • Systematic disruptive behavior; • Systematic disregard of the instructors' directions; • Use of alcohol or drugs, smoking; • Theft or conversion of the camp's or other person's property to their own use; • Any damage of camp or other person’s property or facilities; • Sneaking out of tents at nighttime. 4. DiscoveryLand Camp is pleased to operate under a fair, equitable and flexible Cancellation/Refund policy: • Cancellations must be received in writing via email to info@discoverylandcamp.com. • Cancellations received at least 30 days prior to camp start date will be refunded except for $100 as administration fee. • Cancellations within 30 days of camp start date will receive a credit voucher toward a future DiscoveryLand Camp session, except $100 (administration fee), valid for three years from date of issue. • There is no refund for arriving late, leaving early, no shows, or expulsion from camp. • In case of injuries and illness within 30 days of camp start date the camper will receive a credit voucher toward a future DiscoveryLand Camp session, valid for three years from date of issue. • Please allow 4 - 6 weeks for refunds by cheque. 5. Phone communication and Visitors. For the overall enjoyment and betterment of both your child and other camp participants, like almost all Canadian overnight camps, we do not encourage parental visits. Exceptions: camper pick up/delivery and registration for more than 2 weeks. For the same reason, we don’t have direct communication between campers and parents. Exceptions are birthdays and medical emergency. Parents have a possibility to call the camp at due time (every day from 3.00 PM to 5.00 PM) and speak to camp staff. 6. Electronic games, cell phones, and unsafe items such as matches, knives, and lighters will be confiscated and kept in administration storage till the end of the session. 7. The Director reserves the right to refuse enrolment if in her opinion it is in the best interest of the camp or the child. 8. Campers with behavioral concerns may require additional supervision in order for them to safely remain at camp. If, in the opinion of the Director, a camper requires extra supervision, and it is reasonable and possible for the camp to provide this extra supervision, it is understood that this additional cost must be assumed by the Parents. 9. Parents agree to pay for any and all damages intentionally caused by their child to camp property and/or the property of others. We appreciate your understanding with respect to our policies and look forward to seeing you this summer! - I have read with my child, understood, agree with and accept DiscoveryLand Camp Policy. To the best of my knowledge my child is in good health and I have fully disclosed all medical, psychological and/or emotional problems or concerns. In the case that the above medical information should change before arriving at camp, I will disclose changes in my child’s health status in writing to the camp. I agree to update the camp of any camp/school issues, (suspension, discipline) or social, emotional, or psychological issue that could affect our child or any other child, prior to camp. In case of emergency, should we not be immediately available for consultation, I hereby give permission to the physician/and or camp staff selected by the Camp Director to hospitalize, secure proper treatment for, and/or to order and secure necessary transportation, injections, anesthetics or surgery for my child, as named above. I hereby waive, release and absolve and agree to indemnify and hold harmless the camp and their respective officers, employees, director and agents from all liability arising from my child’s participation in their program. I confirm that my child is capable of participating safely in the full program including all trips/kayaking trips and all activities unless I advise you otherwise in writing and I acknowledge that such participation involves risks and hazards incidental thereto all of which are assumed by me. I agree to be responsible for any extra medical expenses incurred by my child or by the camp on behalf of my child. I acknowledge that any medical treatment will be performed in the Province of Ontario and that the Courts of Ontario shall have exclusive jurisdiction over any claim, legal dispute or cause of action arising out of my child’s stay at DiscoveryLand Camp, or his/her medical treatment, including any relationship with a physician, nurse or hospital. I hereby agree that if I commence any such legal proceedings they will be held only in the Province of Ontario and I hereby irrevocably submit to the exclusive jurisdiction of the Courts of the Province of Ontario.

By SUBMITTING this form I acknowledge that I have carefully read, understood and agree to the DiscoveryLand Camp Terms and Conditions

Parent/ Guardian - Responsible for camp registration:

Parent/ Guardian Name*

Parent/ Guardian's Email*

10+2=? *