Form Builder

Consent Form

Thank you for taking the time to fill out this vital form for your youth.  All forms must be completed by May 17, 2021.  Thank you for adhering to our deadlines. 

This is a leadership program designed to teach youth independence and confidence. As a result, we will always contact the youth first and only involve parents/guardians for emergencies or significant behaviour/disciplinary conversations. We appreciate your support in this matter.

Medical Information

If your youth has medication to be administered during program time, you will need to inform our staff on Monday morning. This medication will need to be kept in the staff area to ensure campers cannot access it.

Main Parent/Guardian Contact Information

In the event of an emergency please list your phone numbers and contact information so we can contact you if needed.

Emergency Contact Information

In the case where we cannot reach the main contact person, please indicate another contact that we can contact.

Emergency Medical Treatment

In the event of an accident or illness involving my youth while attending and volunteering in programs I hereby authorize, if I am not immediately available, the administration of any medical procedure deemed necessary by the youth's physician, or any other physician selected by the program staff.  I also give my permission for my youth 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 youth to the hospital if required; billing for the ambulance will be forwarded to the master contact specified on the registration form.

Excursions off the Property

The camp your youth is volunteering at 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 as may, from time to time, be scheduled as part of the program.  Staff members are not allowed to drive participants for any reason.  Routine activities for camps may include walking to and from the park, swimming in a lifeguarded pool and visiting the splash pad at Waterloo Park.  Please note that you will be required to sign an informed consent form listing the details if there are more excursions off the property than what is listed. 

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. 

To the extent that the foregoing information constitutes personal information under the Municipal Freedom of Information and Protection of Privacy Act, 1989, the information is collected under the authority delegated to the City of Waterloo by virtue of the Revised Statutes of Ontario and will be used for the purposes indicated or implied by this form.  Questions about the collection of personal information should be directed to City Clerk, City Hall, Waterloo City Centre, Waterloo, Ontario, N2J 4A8 519-747-8705.