SONIASHNYK CULTURAL LEARNING PROGRAM REGISTRATION

Available for 3 terms, 5 days a week. Weekly program includes help with homework, Ukrainian and Canadian heritage lessons, English lessons, sports activities, arts and crafts, dance and singing. Located at 145 Evans Avenue, Toronto M82 5X8.

Please complete ALL sections of this form as applicable, there are 5 pages to submit. By completing this form you are acknowledging that you are waiving certain legal rights and hereby warrant and represent to Soniashnyk Cultural Learning Program as well as the Ukrainian National Federation of Canada (including and any and all of its branches), and any of their respective affiliates, directors, officers, volunteers, staff and employees, contractors, representatives, licensees, agents, or successors (collectively, the “Organization”) that: (1) you are over the age of majority in your jurisdiction of residence; and (2) you are registering on behalf of minor and are the minor’s parent or legal guardian and are fully authorized and permitted to enter into this agreement on behalf of the minor Participant.

01. Participant’s Details (As Given on Health Card)

Photo of Participant must be in .jpg or .pdf format.
Click or drag a file to this area to upload.

02. Participant’s Physical Description

03. Participant’s Address

04. Parent(s) or Guardian(s) Information With Whom Participant Resides:

05. Additional Parent(s) or Guardian(s) Information

06. Emergency Contact Details

A 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 - After School Program to contact the individuals below in the event that I am not immediately available.

07. Participant's Physician Details

08. Pre-Existing Medical Conditions and Allergies

If 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.

9. Soniashnyk Cultural Learning Program Payment Information

Winter and March Breaks

We will offer a full day camp program during both breaks which will be a separate fee and registration.

10. Parent Signature and Acknowledgement Soniashnyk Cultural Learning Program:

I give permissions for the Participant to leave the Camp premises to participate in field trips and I give permission to the staff of 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.
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, Soniashnyk Cultural Learning 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 Soniashnyk Cultural Learning 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.
I give permission for the Participant to participate in all Soniashnyk Cultural Learning 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 Soniashnyk Cultural Learning 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 Soniashnyk Cultural Learning 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 Soniashnyk Cultural Learning 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.
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 Soniashnyk - Soniashnyk Cultural Learning Program, 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.
I confirm that I have read and understand the Soniashnyk Cultural Learning 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. Soniashnyk Cultural Learning Program reserves the right to cancel the Participant's participation in the Soniashnyk Cultural Learning Program and any of its programming if the Participant’s behaviour is deemed unmanageable, inappropriate or dangerous in the Soniashnyk Cultural Learning 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 Soniashnyk Cultural Learning Program.
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 Soniashnyk Cultural Learning Program and/or the administration of the Participant’s programming.
I agree to be contacted in regards to Soniashnyk Cultural Learning 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 Soniashnyk Cultural Learning Program dates by contacting [email protected]. I understand once my name is removed I will not be contacted for early registration
I acknowledge that in case of a snow storm the Soniashnyk Cultural Learning Program will be cancelled for a day and I will receive a refund for that day.

11. Signature of Both Legal Guardians

By 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.

APPENDIX "A" - Medical and Safety Information Form

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.