Form Builder

Consent Form

All forms must be completed a week prior to the first day of camp. 

Thank you for completing this vital form for camp.

 


Main Parent/Guardian Contact Information

Please list your phone numbers and contact information so we may contact you in the event of an emergency. 

Emergency Contact Information

In a case where we cannot reach the main contact, we will try to reach the alternate contact.


Parent/Guardian Names for Drop off and Pick up

Please indicate who has permission to drop off and pick up your child from camp. Please note that photo ID will be required by staff. If someone other than the names listed is to pick your child up from a site, our leaders will require the main contact's written consent.

Medical Information

If medication is to be administered during program time, a medical administration form must be completed on the first morning. This form may be obtained from the leaders at your program site. Note: camp staff cannot administer any medication other than oral medication and can assist with epi-pens if needed.


If your child has a disability or special need and requires accommodation to participate in our programs, one-to-one assistance may be available. Accommodation fills quickly - please register early to ensure support is available. Learn more at www.kitchener.ca/leisuresupport or call 519-741-2229.

Emergency Medical Treatment

In the event of an accident or illness involving my child while attending the program I hereby authorize, if I am not immediately available, the administration of any medical procedure deemed necessary by the child's physician, or any other physician selected by the program staff.  I also give my permission for my child to be transported to the physician's office or the hospital Emergency Department with no liability on the drivers's part.  An ambulance may be called to transport my child to the hospital if required; billing for the ambulance will be forwarded to the main contact specified on the registration form.

Excursions off the Property

The child(ren) listed above may be taken away from the program premises by the staff, by means of any manner of public or private transportation or otherwise, for walks, picnics or outings of any kind and may, from time to time, be scheduled as part of the program.

Routine activities for Summer Adventure Camp, Variety Camp and Evolve Skateboard Camp may include walking to and from the park, swimming in a lifeguarded pool or visiting the splash pad at Waterloo Park.  

Routine activities for Fun Centres, Focus on Nature, Director's Cut, LEGO Robotics and Coding, or Little Medical may include walking to and from the parks, walking on trails in and around the facility as well as using the green space in and around the facility.

Routine activities for Sportball Camp may include using the green space in and around the facility and walking to and from the park.

Please note that you will be required to sign an informed consent form listing details if there are more excursions off the property than what are listed. Staff do not drive participants for any reason.

Authorization for publicity

The above mentioned participant(s) may appear in advertising/publicity arranged by the City of Waterloo through various media outlets including newspaper, radio, tv, slide presentations and printed or electronic publications.

Parent/Guardian Consent

As the participants parent or guardian, I have read and understood the specific program details outlined above and give permission for participation.