2018Under18

Counselor Appreciation day 2018

Sunday, November 4th 2018.
11:00am to 2:00pm: Pizza lunch, Praise & Worship. Basement, St. Theresa's Catholic Parish - 7508 - 29 Avenue

2:00pm to 5:00pm: Swimming; Millwoods Recreation Centre, 7207 - 28 Ave NW, Edmonton

Participant registration form for those under 18!

* Indicates required field

Name *

First

Last

Date of Birth *

Parish *

Gender *

Male Female

Address *

Line 1

Line 2

City

State

Zip Code

Country

Please indicate any food allergies or special dietary requirements. If there are none, please put N/A *

Please indicate if there are any medical conditions that camp needs to be made aware of for your child to participate in this event. *

Parent/Guardian Name *

First

Last

Parent/Guardian Cell Phone Number *

Parent/Guardian Email *

Alternate Emergency Contact *

First

Last

Emergency Contact Phone Number *

Camp Encounter Waiver and Consent
This must be signed by a parent or legal guardian for participants under the age of 18.

I request that my child, named above, be permitted to participate in the Camp Encounter Counsellor Appreciation Event on November 3rd, 2018. I understand that the program will include a pizza lunch with fellowship and Praise & Worship at St. Theresa's Parish, 7508 - 29 Avenue and then swimming in the pool at the Millwoods Recreation Centre, 7207 - 28 Avenue, Edmonton. If a medical emergency involving my Child should arise during the event I understand that I will be contacted as soon as reasonably possible. I authorize Camp Encounter, its staff and volunteers to obtain medical treatment for my Child, and to consent to medical treatment on behalf of my Child. The medical information I have provided is correct, so far as I know, and mu child has permission to engage in all prescribed activities except as noted by me. In consideration of my Child, being permitted to participate in the Camp Encounter Counsellor Appreciation Event, I, on behalf of myself, my Child, and our respective heirs, executors, administrators, and assigns, do hereby release Camp Encounter and The Catholic Archdiocese of Edmonton, its staff and volunteers, (collectively, the "Releasees"), from any claims, demands, or actions arising out of any loss, injury, or damage to my Child's person or property, notwithstanding that any such loss, injury or damage may have arisen by reason of the negligence of the Releasees. I understand that my Child shall be required to abide by all the rules of this Camp Encounter Event, which will be provided to him/her, and that my Child's failure to follow these rules may result in my Child's immediate dismissal from the event at my expense.

Signature of Parent or Guardian *

Date *

Submit