Camp 2019 Registration Form for children 4* to 12 years www.ypce.com

Child’s Last Name First Name

Home Address City Postal Code

Home Phone DOB (d/m/y)

Age as of July 1, 2019: ____________ Gender: Male Female Does your child attend a YPCE Kid’s Club? Yes No If yes, please advise location:

Parent/ Relationship Guardian First Name Last Name to child

Home Address City Postal Code

Home Phone Cell Email

Business Name

Business Address City Postal Code

Business Phone Extension _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Parent/ Relationship Guardian First Name Last Name to child

Home Address City Postal Code

Home Phone Cell Email

Business Name

Business Address City Postal Code

Business Phone Extension

Authorized Contact(s) If Parent/Guardian Cannot Be Reached (to pick up in case of an emergency) First Name Last Name Home Phone

Address Business Phone

City Postal Code Cell Phone Relationship to child ________________________________________ First Name Last Name Home Phone

Address Business Phone

City Postal Code Cell Phone Relationship to child ________________________________________

Please check the location you wish to register for:

Andrew Hunter Children’s Academy 59 Lampman Lane, Barrie, Tel: 705-739-1350

Trillium Woods Children’s Academy 20 Elmbrook Drive, Barrie, Tel: 705-728-5430

Hewitt’s Creek Children’s Academy 41 Sandringham Drive, Barrie Tel: 705-737-5430

*Children must be 4 years of age by June 30. Ask about child care options for preschool children.

Please turn over

Child’s Medical Information

Physician’s Name _____________________________________________________ Physician’s Phone # _________________________________ Physician’s Address ___________________________________________ City ____________________________ Postal Code ________________ List Any Special Medical Information: Allergies, Chronic Conditions, Asthma, Seizures, Diabetes, Etc. ______________________________________________________________________________________________________________________

Does your child have an Epinephrine Auto Injector (Epi-pen)? Yes No Does your child have an Inhaler? Yes No Yes, my child has been fully immunized as per Public Health recommendations. Please provide a copy of your child’s immunization record if under 44 months of age

No, my child has not been fully immunized as per Public Health recommendations. Provide one of the following documents.

• A notarized Ministry of Education approved Statement of Conscience or Religious Belief form • Ministry of Education approved Statement of Medical Exemption form (completed by a doctor or nurse practitioner

Camp Sessions: Please check the weeks you wish to register for: Camp operates 7:00 am to 6:00 pm. No meals/snacks are provided by YPCE.

*Short week, fees calculated based upon 4 days, all other weeks 5 days. Please include the following:

A completed and signed Summer Camp Registration form

A non refundable deposit cheque in the amount of one week’s fees made payable immediately (to be applied to the last week of camp for which your child is registered). All cheques payable to YPCE.

Postdated cheques for all other chosen weeks (All July sessions-postdate for July 2, 2019 and All August sessions-postdate for August 1, 2019)

Exploration Summer Camp contract Parent Waiver Parent Signature: Date: Billing Name: __________________________________ Note: Tax Receipt will be issued to the person listed in Billing Name Please return all forms and payment to the Supervisor.

Our Camp is nut aware. This means we do not serve nut products, but are not responsible for food served that may contain traces of nuts as indicated on the packaging. For the safety of our campers, we ask that you do not send food with nuts with your child to Camp. It is expected that all children including those on any medication will still be able to participate fully in all the camps programs and activities.

Tax receipts will be issued in February of the following year.

Revised 01/28/19

Sessions 1* 2 3 4 5 6* 7 8 9

Dates Jul 2-5 (closed Jul 1)

Jul 8-12 Jul 15-19 Jul 22-26 Jul 29-Aug. 2 Aug. 6-9 (closed Aug 5)

Aug.12-16 Aug.19-23 Aug.26-30

Cost $215.00 $226.00 $226.00 $226.00 $226.00 $215.00 $226.00 $226.00 $226.00

Office Use: Deposit Rcvd $___________ chq#______ Subsidy Daily rate: ___________ July payment $_______________ chq#______ Contract rcvd Aug payment $_______________ chq#______ Waiver rcvd Immun/Statement of Con. rcvd

Summer Camp 2019 Contract

www.ypce.com

Summer Camp Contract Between:

York Professional Care & Education (Summer Camp) hereinafter referred to as the “AGENCY” and _______________________________________(name of parent or guardian) hereinafter referred to as the “PARENT”. Whereas the PARENT has requested that the AGENCY arrange child care services (hereinafter referred to as the “SERVICES”) for their child_____________________________________________(name of child) hereinafter referred to as the “CHILD” And whereas the AGENCY has agreed to arrange for the SERVICES to be provided on a bi-weekly basis. And whereas the AGENCY is licensed by the Government of Ontario as a non-profit corporation to provide such SERVICES and is accountable to the Ministry of Education. And whereas the PARENT acknowledges and agrees to the Rules, Regulations, Policies and Procedures of the AGENCY. The Parent therefore understands and agrees to the following terms:

York Professional Care & Education reserves the right to cancel any camp session if a minimum number of participants have not registered two weeks prior to the program starting. YPCE will issue full refunds if this occurs. Refunds are not granted if the parent/guardian withdraws a camper before the end of the session, if the camper arrives with a communicable disease or is sent home for misconduct. Fees are refundable, less the non-refundable deposit with two weeks’ notice. Thereafter, they are refundable only for medical reasons with a doctor’s certificate. Any requests for refunds must be made in writing to the Supervisor prior to the start of the session. Administration fee may apply.

To pay a late fee to the Camp Counselor attending to the CHILD, if the CHILD remains at the Camp program past the scheduled pick-up time. If the PARENT does not contact the Staff or cannot be reached by 7:00 p.m., it is understood that the Police and the Children’s Aid Society will be notified.

To pay an automatic penalty of $50.00 for any payment returned Non-Sufficient Funds and to pay interest on outstanding accounts.

To inform the Agency in writing if the CHILD is involved in a custody dispute, and to provide the Supervisor with a copy of the court order custody papers.

To withdraw the CHILD from SERVICES without notice if the Supervisor, after discussion with the PARENT, and in consultation with resource staff, determines that the CHILD is exhibiting deliberate and/or persistently violent or disruptive behaviour, OR that the PARENT has not fully carried out the terms of this Contract or the PARENT responsibilities under the policies and procedures pertaining to these SERVICES.

To complete the Parent Waiver regarding York Professional Care & Education using any photos/videos taken of my child in its promotional materials, website and social media and the use of photos of my child in Centre displays.

Summer Camp 2019 Contract

www.ypce.com

To complete the Parent Waiver regarding my child applying their own sunscreen and for Staff to assist as required. It is my responsibility to supply sunscreen and to label it with the child’s name.

To complete the Parent Waiver regarding only authorized persons, as designated on the Registration Form, are allowed to pick up the CHILD.

To submit completed immunization records or a Statement of Conscience or Religious Belief form or Statement of Medical Exemption form if applicable, PRIOR to the child commencing camp.

To the administration of medication on the conditions stated in the “Policy and Procedures for Administration of Medications”.

To consent for walks and activities off premises, and all field trips for the week(s).

To give the Supervisor permission to transport the CHILD to a nearby physician or hospital, and to authorize medical treatment necessary for the CHILD’S welfare and good health, including ordering the administration of medication, injections, anaesthesia, surgery, or any other medical procedures deemed necessary in the circumstances by the treating physician. I understand and agree that where possible, the Supervisor will attempt to notify me before seeking and obtaining medical attention. However, if I cannot be contacted or in the event of an emergency, authorize the Agency to obtain immediate medical treatment for the CHILD and to notify me as soon as possible.

To reimburse the Agency for any additional expenses that may result from the provision of the above medical services and/or transportation for medical care. I also confirm that the CHILD is covered by the Ontario Health Insurance Plan or equivalent medical insurance.

To release York Professional Care & Education Inc. (individually and together hereinafter referred to as the Agency, its trustees, directors, related corporations, employees, staff and agents) from any liability for any loss, personal injury, accident, misfortune or damage to the CHILD or his/her property, with the understanding that reasonable precautions shall be taken to ensure the health and safety of the CHILD.

I acknowledge that my CHILD attends the Camp and participates in its activities at his/her own risk.

I have read, understand and agree to this contract.

Parent/Guardian Signature ________________________________ Date: _________________.

Revised 01/24/19

Parent Waiver Allowing for special circumstances.

Revised 01/24/19

Date ____________________________ Child __________________________________ Parent/Guardian_____________________________________ Please Answer All Circumstances by Circling - YES / NO / NA. 1. I give permission for York Professional Care & Education to use any photos/videos taken of my

child for promotional materials, website and social media. Yes / No / NA 2. I give permission for the use of photos of my child in Centre/Camp displays. Yes / No / NA 3. I allow my child to play on riding equipment without a helmet. Yes / No / NA

4. I allow my child to make choices regarding outdoor dress. I understand that a staff

does not force a child to wear particular items and that my child cannot stay indoors as an alternative. Yes / No / NA

5. I allow my School-age child to apply their own sunscreen; and for staff to assist when required. Yes / No / NA It is the parent’s responsibility to supply sunscreen and to label it with the child’s name.

6. My child will not wear sunscreen. Yes / No / NA

7. I accept full responsibility to ensure the safe arrival of my child to the program without accompanying them into the program. Yes / No / NA

8. I give permission for my child to □ arrive late to, or □ be dismissed early from the program

on (day/s) __________________________ at approximately (time) ________________, for the purpose of __________________________ until (date)____________________. Yes / No / NA

9. I instruct staff to dismiss my child unattended from the program. Yes / No / NA 10. I instruct staff to release my child to the care of (name)__________________________,

in full knowledge that this person is not of legal age. Age: ______. Yes / No / NA 11. I instruct staff to release my child to the care of (name)__________________________,

on (day/s)______________________________ at approximately (time)______________ until (date)_______________________. This person will accompany my child back to the program at approximately (time) ________. Yes / No / NA

I understand that by completing this waiver I release and relieve York Professional Care & Education from all responsibility; including accident or injury that may occur to my child while NOT under the direct supervision of centre staff. Parent Date Supervisor Date