LetsPlay Summer Camp Registration Form Version 2.0 – March 2023
Camper Name: __________________
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First _______________________________ Middle _________________ Last _______________________ Gender: Male __ Female__
School Name (if applicable): __________________________________ Grade _______ Birth date _____/_____/______ Age _____
Street Address _________________________________________________________________________________________________
City ________________________ Province:______ Postal Code ___________ Child’s Home Phone _______________________
Child lives with: _____________________________________________________________________________________________
Person responsible for payment ___________________________________________________________________________________
Parent/Guardian – Contact Information
Parent/Guardian #1
Street Address ________________________________________________________________________________________________
City ____________________ Province ____ Postal Code ________ Home Phone ________________ Work Phone _________________
Cell phone ______________________________ FAX _________________________ E-mail _________________________________
Occupation _____________________________________________ Employer _____________________________________________
Parent/Guardian #2
Street Address_________________________________________________________________________________________________
Town/City ____________________ State ___ Zip code ________ Home Phone ________________ Daytime phone _______________
Cell phone ______________________________ FAX _________________________ E-mail _________________________________
Occupation _____________________________________________ Employer _____________________________________________
Emergency Contact Information – Alternate Pickup/Release
Emergency Contact #1
First Name ___________________ Last Name ___________________ Home Phone ________________ Work Phone ______________
Cell Phone ___________________ Email _____________________________________ Relation to child ______________________
Emergency Contact #2
First Name ___________________ Last Name ___________________ Home Phone _______________ Work Phone _______________
Cell Phone ___________________ Email _____________________________________ Relation to child _____________________
Please list those people including in addition to parents/guardians who are permitted to pick up your child:
1: ____________________________________ 2: ________________________________ 3: _________________________________
Medical Information
Please list any medical problems, including any requiring maintenance medication (i.e. Diabetic, Asthma, Seizures allergies).
Medical Problem Required Treatment Should paramedic be called?
_______________________________ _______________________ Yes/No
_______________________________ _______________________ Yes/No
_______________________________ _______________________ Yes/No
Is your child presently being treated for an injury or sickness, or taking any form of medication for any reason?
Yes__ No__ If yes, explain: _____________________________________________________
Is your child allergic to any type of food or medication?
Yes__ No__ If yes, explain: ______________________________________________________
Does your child require a special diet?
Yes__ No__ If yes, explain: ______________________________________________________
The purpose of the above-listed information is to ensure that medical personnel have details of any medical problem which may interfere
with or alter treatment.
$250 deposit is due at the time of camp registration. This deposit will be put towards camp tuition.
LetsPlay Summer Camp Registration Form Version 2.0 – March 2023
Camper Name: __________________
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Summer camp tuition fee is due on every Monday the week that your child is enrolled, either by cash or credit card. If a
camper’s tuition is not paid they will not be able to attend camp. Please note that we do charge for holidays, sick days and
any absent days. Payment will be require in full including holidays if any in that week, sick days or absent days.
Please select from the following payment options:
o Full Summer
o Week 1 – $250
o Week 2 – $250
o Week 3 – $250
o Week 4 – $250
o Week 5 – $250
o Week 6 – $250
o Week 7 – $250
o Week 8- $250
o Week 9- $250 Camp Tuition Total: ___________
The financially responsible party signing this form understands and agrees to follow the Tuition Payment and Fees Policy.
Terms of Agreement
Photo Release
I hereby give permission for my child to be photographed during the LetsPlay Summer Camp. I understand the photos will be used to
keep a journal of activities, to share during power point presentations and/or reports and for promotional purposes including flyers,
brochures, newspapers and on the internet. I understand that although my child’s photograph may be used for advertising, his or her
identity will not be disclosed, I do not expect compensation and that all photos are the property of Feather Lets Play Summer Camp.
Parent’s/Guardian’s Initials ____________
LetsPlay and its organizers are not responsible for lost or damaged personal property. All scheduled events are subject to change. I
understand that no fees will be refunded or transferred. Photos and quotes may be used for publicity purposes.
Guardian Signature: __________________________________________________________ Date: __________________________
Printed Name of Parent/Guardian: _______________________________________________
Coordinator Signature:
Director Signature: _______________________________________________
LetsPlay Summer Camp Registration Form Version 2.0 – March 2023
Camper Name: __________________
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Participation Consent Form
I, the undersigned*, herby release discharge, indemnify, hold harmless and defend LetsPlay its employees and
volunteers from any and all liability (claims, demands, losses, causes of action, suits, judgements) of any kind that
I or my family may have against LetsPlay due to death, personal injury or illness, loss or damage to property, or
future causes that occur during the LetsPlay Summer Camp. In the event of any medical emergency, I authorize
and consent to LetsPlay to act on behalf of the medical care deemed necessary for the participant.
Name of Participant
Name of Parent
Health Card Number
Health Insurance Policy Number
Family Doctor Phone Number
*Parent Signature
Contact Phone Number Date
LetsPlay Summer Camp Registration Form Version 2.0 – March 2023
Camper Name: __________________
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Assumption of Risk
I understand and acknowledge that the Summer Camp Program involves outdoor, wilderness travel and may
include (but shall not be limited to) the following activities: walking, running, playground and splash pad
activities. I understand that my child(ren) may engage in activities not listed above. I am aware that participation in
the Summer Camp program involves risks to personal safety and physical risks, which can range from (but are not
limited to) minor injuries such as scratches, bruises, and sprains to catastrophic injuries, including paralysis and
death. Some, but not all of the risks I may encounter include: extreme or inclement weather (including thunder and
lightning), physical contact with other participants or individuals; or misjudgment by the LetsPlay leaders,
volunteers, other staff or contractors; local flora and fauna, and risk of infection/disease. I am voluntarily
participating my child(ren) at the Program with knowledge of, and hereby accept and assume the risks, dangers
and hazards involved, including responsibility for any losses, costs and damages arising out of such risks, dangers,
and hazards.
I understand that LetsPlay owns and operates a privately owned bus for private transportation to and from various
activities. I understand that allowing my child(ren) to participate in these activities carries a certain amount of risk.
I hereby release and hold harmless LetsPlay, their owners, employees, volunteers, agents, and insurers, and any
and all cooperating institutions and their officers, agents, employees and insurers (collectively, the “Releasees”)
from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, in any way
associated with my participation in the Program. I understand that this Waiver discharges the Releasees from any
liability or claim that I may have against the Releasees with respect to bodily injury, personal injury, illness, death,
or property damage that may result from my participation in the Summer Camp Program and busing