UNF CAMP SOKIL 2024 REGISTRATION BACK Please enable JavaScript in your browser to complete this form.StatusPendingDeclinedCompleted01. Participant’s Details (As Given on Health Card)Surname *Given Name *Parent's Email *Health Card Number *Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Paste Participant’s Photo *Photo of Participant must be in .jpg or .pdf format. Click or drag a file to this area to upload. Are you here on CUAET? *YesNoCUAET Visa Number *Arrival Date *Upload Child's Visitor Record or Study Permit * Click or drag a file to this area to upload. 02. Participant’s Physical DescriptionSex * MaleFemaleWeight (kg) *Height (cm) *Eye Colour *Hair Colour *T-shirt Size * Kids SmallKids MediumKids LargeAdult SmallAdult MediumAdult Large03. Participant’s AddressAddress *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountry04. Parent(s) or Guardian(s) Information With Whom Participant Resides:Guardian #1 Full Name *Guardian #1 Contact Number *Guardian #1 Email *Guardian #2 Full NameGuardian #2 Contact NumberGuardian #2 EmailMember of the Ukrainian National Federation? *YesNoIf Yes, Indicate which (city) Branch: *05. Additional Parent(s) or Guardian(s) InformationFather's (or Guardian's) Full Name Father's (or Guardian's) NumberFather's (or Guardian's) EmailMother's (or Guardian's) Full NameMother's (or Guardian's) NumberMother's (or Guardian's) EmailMember of the Ukrainian National Federation?YesNoIf Yes, Indicate which (city) Branch:Are there any court orders or custody restrictions which would prevent us from communicating with either guardian?YesNoIf Yes, please describe:06. Emergency Contact DetailsA minimum of two Emergency Contacts over the age of 16 are required and must be different from the parents and guardians listed above. I authorize Soniashnyk - UNF Children's Program to contact the individuals below in the event that I am not immediately available.Emergency Contact #1 Full Name *Relationship to Participant *Work *Cell *Emergency Contact #2 Full Name *Relationship to Participant *Work *Cell *07. Participant's Physician DetailsPhysician's Full Name *Physician's Number *08. Pre-Existing Medical Conditions and AllergiesIf there are any special needs, medical conditions, allergies, dietary restrictions, behavioural or physical concerns, that would interfere with the child's camp life and activities please complete Appendix A at the end of this application.Has the participant been exposed to any infectious diseases recently? ( Covid, chicken pox, mumps etc) *YesNo I am aware that Camp Sokil Program is a nut free environment but that the absence of potential allergens cannot be guaranteed. *Agree9. Camp Sokil Registration (Please Check All Weeks That Apply) PRICING: UNF Member - $550 + HST($71.50) Non-member Early Bird* - $550 + HST($71.50) Non-member Late Owl - $600 + HST($78) *Early bird deadline April 30, 2024* 5% discount with every additional child Registration Weeks - Youth (13-15 yrs)Week 1: July 7-13Week 2: July 14-20Week 3: July 21-27Registration Weeks - Children (6-12 yrs)Week 3: Aug 11-1710. Parent Signature and Acknowledgement - Camp SokilAUTHORIZATION FOR FIELD TRIPS *I give permissions for the Participant to leave the Child premises to participate in field trips and I give permission to the staff of Camp Sokil to take the Child to all scheduled trip locations during the session in which the Child is registered. I agree that the Child may be transported by to trip sites by school bus, public transportation or walking. I understand that the Child will be escorted and supervised by Child staff during this trip. AgreeMEDICAL AUTHORIZATION AND RELEASE *I hereby consent to any first aid treatment or medical emergency treatment being given or provided to the Participant as may be necessary or warranted under the circumstances and hereby give permission that in the case of an emergency and I cannot be immediately reached, UNF Children's Program staff may hospitalize and authorize treatment for the Participant, including but not limited to the provision of anesthetics, injections and/or surgery. I also give permission for UNF Children's Program staff to transport the Participant to the emergency department at the nearest hospital, without any liability on the part of the staff member. Furthermore, I agree to accept financial responsibility for any costs associated with the Participant receiving medical treatment. I also agree that the information in this Form and any attachments hereto can be disclosed to emergency and health personnel. I confirm that I have provided complete and accurate medical information for the Participant and permit the Participant to participate in the full range of Program activities, except as I have explicitly noted on the Medical Information Form attached hereto as Appendix "A" on page 5. I hereby agree and undertake that I will use best efforts to make myself available and be reachable at either of the phone numbers I have listed in this Form at all time.AgreeRELEASE AND INDEMNITY *I give permission for the Participant to participate in all UNF Children's Program activities and I understand that some of the activities, such as but not limited to, canoeing, swimming and water sports, may be inherently dangerous and/or involve risks. In consideration of the Participant’s opportunity to participate in the UNF Children's Program, the receipt and sufficient of which is hereby acknowledged, I hereby release and forever discharge the Organization in respect of any and all claims, actions, losses, damages, costs, and expenses, including but not limited to loss of income, in relation to any and all personal injury to or death of the Participant or any other person, or any loss of or damage to property, arising in any way at, from or in connection with the UNF Children's Program and services and any and all matters set out in this Registration Form, howsoever caused, and I agree to indemnify and save harmless the Organization with respect to same. I am providing this release and indemnity on behalf of the Participant, as well as in my personal capacity on my own behalf, and on behalf of my spouse and any other persons who may be entitled to assert such a claim, and agree that this waiver and indemnity shall be binding on my personal representatives, heirs and successors. I understand that although every effort is made to send Participants home with all of their belongings, the UNF Children's Program is not responsible for any loss or damage. I have read this Form and any attachments hereto fully, and understand its terms and that I am giving up substantial rights by signing it. I have signed this form freely, voluntarily and without any inducements or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this Form and any attachments hereto are held to be invalid, the remaining terms and provisions shall continue to be in full force and effect. I confirm having been advised that I should obtain independent legal advice prior to signing the Registration Form and any attachments thereto.AgreeMEDIA RELEASE *I hereby authorize any images or recordings taken of the Participant and/or me, as applicable, and any work, art or performance of the Participant(“Work”), in relation to the Participant’s participation in Camp Sokil, to be used by the Organization for promotional, informational, publicity, and marketing purposes, and authorize the publication and/or display of said materials publicly, whether on a website, social media, television, in print or otherwise. I also consent to the release of the Participant’s name but only as it relates to the Participant’s participation in the Participant.I hereby relinquish all rights, title, interest and royalties I and/or the Participant may have in any of the said images, recordings, and Work, and hereby release the Organization from any and all claims or demands for damages of any kind whatsoever arising from the Organization’s use of said materials. I understand that said materials may be used and may be reproduced by third parties and I agree that I will not hold the Organization responsible for any harm or damages that may arise as a result.AgreeDisagreeCAMP SOKIL PROGRAM POLICY *I confirm that I have read and understand the Camp Sokil Program Policies outlined in the Policy Book which were sent to me via email at time of confirmation of registration and I agree to abide by and be bound by the policies. I further confirm having reviewed the policies with the Participant. Camp Sokil reserves the right to cancel the Participant's participation in the UNF Children's Program and any of its programming if the Participant’s behaviour is deemed unmanageable, inappropriate or dangerous in the program’s sole discretion, in which case any registration fees paid will be non-refundable, and I hereby acknowledge and agree that I will be responsible for any and all costs associated with such dismissal. I also have read and understand the refund policy where no refunds or credits may be applied after registration is confirmed, whether or not the Participant has attended UNF Children's Program.AgreeRELEASE OF INFORMATION *I hereby agree that the information in this Form and any attachments hereto can be disclosed to the Organization as applicable in relation to the Participant’s participation in the UNF Children's Program and/or the administration of the Participant’s programming.AgreePRIVACY POLICY *I agree to be contacted in regards to UNF Children's Program News and Events during, but not restricted to, the duration of participation. I acknowledge that I may remove my name from the contact lists at anytime past UNF Children's Program dates by contacting [email protected]. I understand once my name is removed I will not be contacted for early registrationAgreeSNOW DAYS AND REFUNDS *I acknowledge that in case of a snow storm the UNF Children's Program will be cancelled for a day and I will receive a refund for that day.Agree11. Signature of Both Legal GuardiansBy signing this Form, I confirm and acknowledge that I have carefully read and fully understand the terms in this Form and any attachments hereto, and that I irrevocably agree to the Terms set out therein.Guardian #1 Printed Name *Guardian #1 Signature * Clear Signature Date *Guardian #2 Printed NameGuardian #2 Signature Clear Signature Date APPENDIX "A" - Medical and Safety Information FormDoes the Participant have any medical conditions which we should be aware of (ie. asthma, diabetes, epilepsy etc.): *YesNoIf “Yes” provide details of condition(s) and severity:Does the Participant require any medications to be administered for his/her medical condition(s)? *YesNoIf yes, please include all medication below. All medications/puffers/injections must be in original packaging with the manufacturer’s instructions enclosed, along with the label from the pharmacy setting out the dispensing and dosage instructions.MedicationStorage InstructionsFrequencyDosageDoes the Participant have any allergies? *YesNoAllergiesSeverityEmergency MedicationDoes the Participant have any behavioural conditions/concerns which we should be aware of? (ADHD, anger management, bedwetting, social anxiety, sleep walking etc.) ? *YesNoIf “Yes”, please provide details of condition(s) and approved action plan.Please list any dietary restrictions beyond allergies:I hereby confirm that the information in this Medical Information Form is complete and accurate I confirm that I will pick up my child within 1 hour if she/he is unwell enough not to participate in the After School Program and will not send my child to After School Program if they are unwell or within 24 hours of having had a fever. I understand that no refunds will be applied for dates missed due to sickness. I authorize After School Program staff to administer any medication/puffers/injections that have been brought with the Participant to After School Program and by signing this Form, and I understand that no medications/puffers/injections are to be kept on the Participant’s person unless otherwise indicated by a doctor in writing. By signing this Form and in consideration of the Participant’s opportunity to participate in the Participant, I hereby release and forever discharge the Organization in respect of any and all claims, actions, losses, damages, costs and expenses in relation to Participant staff administering any medications/puffers/injections as set out herein, howsoever caused, and agree to indemnify and save harmless the Organization with respect to same.Guardian #1 Printed Name *Guardian #1 Signature * Clear Signature Date *Guardian #2 Printed NameGuardian #2 Signature Clear Signature DateSubmit