UNF SONIASHNYK CHRISTMAS BREAK REGISTRATION BACK Please enable JavaScript in your browser to complete this form.StatusPendingDeclinedCompleted01. Camper's Details (As Given on Health Card)Surname *Given Name *Parent's Email *Health Card Number *Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Camper's Photo * Click or drag a file to this area to upload. Photo of Camper must be in .jpg or .pdf format.Are you here on CUAET? *YesNoArrival Date *02. Camper's Physical DescriptionSex * MaleFemaleWeight (kg) *Height (cm) *Eye Colour *Hair Colour *T-shirt Size * Kids SmallKids MediumKids LargeAdult SmallAdult MediumAdult Large03. Camper's Home AddressAddress *Address Line 1Address Line 2CityState / Province / RegionPostal CodeCanadaAfghanistanAlbaniaAlgeriaAmerican 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 Camper Resides:Guardian #1 Full Name *Guardian #1 Contact Number *Guardian #1 Email *Guardian #2 Full Name *Guardian #2 Contact Number *Guardian #2 Email *Is Parent/Guardian a member 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) EmailIs Parent/Guardian a member of the Ukrainian National Federation?YesNoIf Yes, Indicate which (city) Branch:Are there any court orders or custody restriction 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 Camp Soniashnyk to contact the individuals below in the event that I am not immediately available.Emergency Contact #1 Full Name *Relationship to Camper *Work *Cell *Emergency Contact #2 Full Name *Relationship to Camper *Work *Cell *07. Camper'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 camper's camp life and activities please complete Appendix A at the end of this application.Has the camper been exposed to any infectious diseases recently? ( Covid, chicken pox, mumps etc) *YesNo I am aware that Camp Soniashnyk is a nut free environment but that the absence of potential allergens cannot be guaranteed. *Agree09. Camper’s General ExperienceHas the camper had any formal swimming instruction? *YesNoIf yes, what level of swimming has the camper achieved? Example: Red Cross Green Badge etc. *10. Christmas Break Registration (Please Check All Weeks That Apply)WEEK 1: $200December 23: Full Day December 24: Until 1pm December 27: Full DayWEEK 2: $290December 30: Full Day December 31: Until 3pm January 2: Full Day January 3: Full Day11. Parent Signature and AcknowledgementAUTHORIZATION FOR FIELD TRIPS *AgreeI give permissions for the Camper to leave the Camp premises to participate in field trips and I give permission to the staff of Camp Soniashnyk to take the Camper to all scheduled trip locations during the session in which the Camper is registered. I agree that the Camper may be transported by to trip sites by school bus, public transportation or walking. I understand that the Camper will be escorted and supervised by Camp staff during this trip. MEDICAL AUTHORIZATION AND RELEASE *AgreeI hereby consent to any first aid treatment or medical emergency treatment being given or provided to the Camper 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, Camp staff may hospitalize and authorize treatment for the Camper, including but not limited to the provision of anesthetics, injections and/or surgery. I also give permission for Camp staff to transport the Camper 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 Camper 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 Camper and permit the Camper to participate in the full range of Camp 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 times. RELEASE AND INDEMNITY *AgreeI give permission for the Camper to participate in all Camp 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 Camper’s opportunity to participate in the Camp, 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 Camper or any other person, or any loss of or damage to property, arising in any way at, from or in connection with the Camp programs 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 Camper, 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 Campers home with all of their belongings, the Camp 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. MEDIA RELEASE *AgreeDisagreeI hereby authorize any images or recordings taken of the Camper and/or me, as applicable, and any work, art or performance of the Camper (“Work”), in relation to the Camper’s participation in Camp Soniashnyk, 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 Camper’s name but only as it relates to the Camper’s participation in the Camp. I hereby relinquish all rights, title, interest and royalties I and/or the Camper 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 from any harm or damages that may arise as a result. CAMP SONIASHNYK POLICY *AgreeI confirm that I have read and understand the Camp Soniashnyk Policies outlined in the Policy Book which were sent to me via email at time of confirmation of registrion and I agree to abide by and be bound by the policies. I further confirm having reviewed the policies with the Camper. Camp Soniashnyk reserves the right to cancel the Camper’s participation in the Camp and any of its programming if the Camper’s behaviour is deemed unmanageable, inappropriate or dangerous in the Camp’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 camper has attended camp. RELEASE OF INFORMATION *AgreeI hereby agree that the information in this Form and any attachments hereto can be disclosed to the Organization as applicable in relation to the Camper’s participation in the Camp and/or the administration of the Camp’s programming.PRIVACY POLICY *AgreeI agree to be contacted in regards to UNF Camp News and Events during, but not restricted to, the duration of camp. I acknowledge that I may remove my name from the contact lists at anytime after camp dates by contacting [email protected]. I understand once my name is removed I will not be contacted for early registration11. 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 Name *Guardian #2 Signature * Clear Signature Date *APPENDIX "A" - Medical and Safety Information FormDoes the Camper 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 Camper 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 Camper have any allergies? *YesNoAllergiesSeverityEmergency MedicationDoes the Camper 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 understand I must pick up my child within a reasonable amount of time if the Camp Director deems them too ill to participate in camp activities. I authorize Camp staff to administer any medication/puffers/injections that have been brought with the Camper to Camp and by signing this Form, and I understand that no medications/puffers/injections are to be kept in the office or on the Camper’s person unless otherwise indicated by a doctor in writing. By signing this Form and in consideration of the Camper’s opportunity to participate in the Camp, I hereby release and forever discharge the Organization in respect of any and all claims, actions, losses, damages, costs and expenses in relation to Camp 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 Name *Guardian #2 Signature * Clear Signature Date *Submit