01. Camper's Details (As Given on Health Card) Surname * Given Name * Parent's Email * Health Card Number * Date of Birth * MM 1 2 3 4 5 6 7 8 9 10 11 12 DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YYYY 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Camper's Photo *
Photo of Camper must be in .jpg or .pdf format.
02. Camper's Physical Description Sex * Male Female Weight (kg) * Height (cm) * Eye Colour * Hair Colour * T-shirt Size * Kids Small Kids Medium Kids Large Adult Small Adult Medium Adult Large 03. Camper's Home Address 04. 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? * 05. Additional Parent(s) or Guardian(s) Information Father's (or Guardian's) Full Name Father's (or Guardian's) Number Father's (or Guardian's) Email Mother's (or Guardian's) Full Name Mother's (or Guardian's) Number Mother's (or Guardian's) Email Is Parent/Guardian a member of the Ukrainian National Federation? Are there any court orders or custody restriction which would prevent us from communicating with either guardian? 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 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 Details Physician's Full Name * Physician's Number * 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. Has the camper been exposed to any infectious diseases recently? ( Covid, chicken pox, mumps etc) * I am aware that Camp Soniashnyk is a nut free environment but that the absence of potential allergens cannot be guaranteed. * 09. Camper’s General Experience Has the camper had any formal swimming instruction? * 10. Camp Session Registration (Please Check All Weeks That Apply)
Week one – December 27 – 29
$225.00 / UNF Member: $213.75
Week two – January 2 – 5
$300.00 / UNF Member: $285.00
* Please Note: Legal guardian of camper must be a UNF member in good standing for 2023. All membership are verified by UNF National Office.
Check the box next to the session(s) you are registering for.
11. Parent Signature and Acknowledgement AUTHORIZATION FOR FIELD TRIPS *
I 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 *
I 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 *
I 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 *
I 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 *
I 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 *
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 Camper’s participation in the Camp and/or the administration of the Camp’s programming.
I 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
. I understand once my name is removed I will not be contacted for early registration
12. 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. Guardian #1 Printed Name * Guardian #2 Printed Name * APPENDIX "A" - Medical and Safety Information Form Does the Camper have any medical conditions which we should be aware of (ie. asthma, diabetes, epilepsy etc.)? * Does the Camper require any medications to be administered for his/her medical condition(s)? * Does the Camper have any allergies? * Does the Camper have any behavioural conditions/concerns which we should be aware of? (ADHD, anger management, bedwetting, social anxiety, sleep walking etc.) ? * 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 #2 Printed Name *