Camper Name: ChildFirst Name Middle Name Last Name Gender School Name (if applicable): Grade Age Date of Birth MM slash DD slash YYYY Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Child’s Home PhoneChild lives with: Person responsible for payment Parent/Guardian - Contact InformationParent/Guardian #1First Name Last Name Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneWork PhoneCell PhoneFaxEmail Occupation Employer Parent/Guardian #2First Name Last Name Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Province Postal Code Home PhoneWork PhoneCell PhoneFaxEmail Occupation Employer Emergency Contact Information – Alternate Pickup/ReleaseEmergency Contact #1First Name Last Name Home PhoneWork PhoneCell PhoneEmail Relation to child Emergency Contact #2First Name Last Name Home PhoneWork PhoneCell PhoneEmail Relation to child Please list those people including in addition to parents/guardians who are permitted to pick up your child:.01 .02 .03 Medical InformationPlease list any medical problems, including any requiring maintenance medication (i.e. Diabetic, Asthma, Seizures allergies).Medical Problem Required Treatment Should paramedic be called?YesNoIs your child presently being treated for an injury or sickness, or taking any form of medication for any reason?Injury or sicknessYesNoIf Yes, Please Explain Is your child allergic to any type of food or medication?Child AllergicYesNoIf Yes, Please Explain Does your child require a special diet?Special DietYesNoIf Yes, Please 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.Deposit: $250 deposit is due at the time of camp registration. This deposit will be put towards camp tuition.Deposit: Deposit of 25% of the total cost required to secure camp registration.Camper Name: SUMMER CAMP TUITION & PAYMENT: 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.Product NamePlease select from the following payment options: Full Summer Week 1 – All Around the World – July 2 to July 5 Week 2 – Exploring my town – July 8 to 12 Week 3 – Aquatic World – July 15 to 19 Week 5 – Olympics – July 29 to Aug 2 Week 6 – Animal Week – August 6 to 9 Week 8 – Last Week of Camp– August 19 to 23 Camp Tuition Total: The financially responsible party signing this form understands and agrees to follow the Tuition Payment and Fees Please note for online payment of fees please e-transfer to inquires@letsplayindoor.ca Policy. Deposit: Deposit of 25% of the total cost required to secure camp registration.Payments are Secured by StripeCancellation Policy. Cancellations must be done minimum 2 week in advance. There will be a cancellation fee of 25%. A full refund will be given within 48 hours of registration. 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. Assumption of Risk 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 transportation. HiddenSelect a ServiceBook a Party Camp
