9. UNF Children's Program Registration (Please Check All Weeks That Apply) Are you a? Cuaet Visa Number PRICING:
UNF Member – $350
Non-member – $400
CUAET Visa – $200
*5% discount with every additional child*
Check the box next to the session(s) you are registering for.
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 - UNF Children's Program: AUTHORIZATION 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 Soniashnyk 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.
MEDICAL 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.
RELEASE 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. MEDIA 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 Soniashnyk - UNF Children's 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. SONIASHNYK - UNF KIDS PROGRAM POLICY *
I confirm that I have read and understand the Soniashnyk - UNF Children's 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 - UNF Children's Program 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.
RELEASE 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.
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
. I understand once my name is removed I will not be contacted for early registration
SNOW 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.
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, the and any attachments hereto, and that I irrevocably agree to the Terms set out therein. Camp Soniashnyk Policies Guardian #1 Printed Name * Guardian #2 Printed Name APPENDIX "A" - Medical and Safety Information Form Does the Participant have any medical conditions which we should be aware of (ie. asthma, diabetes, epilepsy etc.): * If “Yes” provide details of condition(s) and severity: Does the Participant require any medications to be administered for his/her medical condition(s)? *
If 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.
Medication Storage Instructions Frequency Dosage Does the Participant have any allergies? * Allergies Severity Emergency Medication Does the Participant have any behavioural conditions/concerns which we should be aware of? (ADHD, anger management, bedwetting, social anxiety, sleep walking etc.) ? * If “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 #2 Printed Name