If you have a child(ren) with Medical Conditions e.g. Asthma, Allergies, Special Needs, then please complete the Medical Form. Please note that camp staff and volunteers are unable to administer medication. Arrangements for guardians to administer during the day on premises can be arranged.
I, the parent or legal guardian of child(ren) listed above, a minor, by submitting this health card number, hereby authorize and give permission to the physician or medical practitioner, selected by Port Church to hospitalize, secure proper treatment including but not limited to the prescription of medications, diagnostic studies, and any other medical procedure for my child)ren) as deemed necessary by the physician under the circumstances. It is understood that this authorization is given in advance of any specific medical treatment being needed, and is given to provide authority to the physician to render that care which in exercise of his or her best judgment is advisable.
1) ETRANSFER auto deposit, please include child[ren]’s full name in the message box along with your email address from this registration form OR
2) Make CHEQUES payable to Port Church with Kids Camp 2021 in the memo line, along with family last name, include last names for both children and parents, if different)
*Registration will not be considered final until payment has been received. Registrations accepted on a first come-first served basis.
**Need special arrangements for making full payment? Please email email@example.com. All payment needs to be made in FULL by June 30, 2021.
***Need to cancel a registration before July 15th, 2021? Refunds minus a $35 registration fee will be granted. After July 20th there are no refunds offered as staff are hired, supplies are purchased and camps are full.
****NOTE: if camp is cancelled due to COVID-19 Restrictions, all monies will be refunded IN FULL.
I agree that photographs and/or videos may be taken of my child at Port Church programs and events, and may be used in the promotion of Port Church. They may be published or used for any application in newspapers, videos, posters, slide presentations, FaceBook, YouTube, other social media and networking sites or otherwise displayed to the public—either in whole or in part by Port Church.
I/We, the parent(s) or Guardian of the above mentioned child, in consideration of my/our child being permitted to enter the Port Church property, and being permitted to participate in Port Church activities and events, AGREE TO WAIVE, RELEASE, DISCHARGE AND COVENANTS NOT TO SUE, its employees, officers, directors, servants and agents from all liability to the child, to myself, or any personal representative of either, assigns, heirs, and next of kin, for any and all claims for damages, for death, personal injury or property damage, suffered by me or my child while participating in any Port Church event or activity. I/WE UNDERSTAND THAT THIS RELEASE AND WAIVER OF LIABILITY applies to any claims occurring from injury to person or property, whether caused by negligence of Port Church or otherwise. I/We acknowledge that the intent of this RELEASE AND WAIVER OF LIABILITY is to prevent Port Church from being held liable for injuries to person or property, and that selecting YES constitutes my/our agreement and the agreement of the child listed above, not to hold Port Church responsible for any damages, losses, injuries to person or property, as a result of any negligence or other wrongful conduct on the part of Port Church or on the part of other third parties. I/We ALSO AGREES TO INDEMNIFY AND HOLD HARMLESS Port Church from any loss, liability, damage, or cost that Port Church may incur due to the presence of myself or said child, upon Port Church premises or in any way using any of Port Church facilities or attending any events of Port Church, whether caused by negligence of Port Church or otherwise. FURTHER, I/WE EXPRESSLY AGREE THAT THIS RELEASE AND WAIVER OF LIABILITY is intended to be as broad and inclusive as is permitted by the law in the Province of Ontario. If any portion is held to be invalid, it is agreed that the balance shall continue in full legal force and effect. I/We further agree that this Release and Waiver of Liability shall be valid for the program season or year. I/We have read and voluntarily agree, and further acknowledge that no oral representations, statements, or inducements apart from the written agreement have been made
I understand that my child is attending a sports camp, and, as such, the space provided will be used by other children
and staff and volunteers which can result in exposure to illness from infectious diseases including, but not limited to
MRSA, influenza, and COVID-19. Although every effort will be made to enforce Ontario’s Covid Safety
Procedures, I realize the potential for exposure still remains. I release the PORT Church staff, volunteers, and board
of directors from any liability, loss, cost, damage or medical expense from personal injury or illness that may arise
out of activities on the church property. While every effort will be made to ensure mine and my child’s safety, I will
not hold PORT Church liable for any accident or other event that may occur.
If desired, please print a copy for your records before hitting the register button!