Lanark Renfrew Health & Community Services
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Summer

Family Relief Summer Camp Registration 2018

*Indicates a required field

Camper Information
Emergency Contact
Medical Information




If yes, please complete the following section:

 
ADMINISTRATION OF MEDICATION CONSENT
Please check the box and Enter your Full Name to indicate your consent for Administration of Medication(s)
DAY CAMP REGISTRATION 2018
*This Summer,  our day camp is being offered in 6 weekly sessions only.   Please select the weeks your child would like to attend.
 
PLEASE   NOTE  DEADLINE FOR CAMP REGISTRATION IS FRIDAY May 4, 2018. 
We will not be able to guarantee a space after this date.
We need your package and payment before we can register your child…….
 
PLEASE CONTACT YOUR CASEWORKER IF YOU HAVE ANY QUESTIONS…
 
Rates for Camp:
Day camp $65 per day
Youth camp $65 per day
Kids just like me  $135
Au-some camp $135
1:1 worker $150 per day

 
Transportation Rates
In Town Trips $5.00 one way
Out of town trips $10.00 one way
Bus transportation $10 each way
 
*Additional fees apply to non-LCP clients

*Please provide the camp with any communication devices.

Eating and Foods


Transportation Information
 
There is an additional cost for transportation each day to and from camp…. if you could drop off       child it would be greatly appreciated.
PLEASE NOTE
Your child will NOT be permitted to leave camp alone unless you call or send a note.

 
If your child requires a car seat or booster seat it must be provided by the family
to travel to/from camp activities in the cars, bus or other transportation vehicles with L.C.P. staff.
 
These arrangements will be made by Lanark Community Programs.
 
Please check the box and Enter your Full Name to indicate your consent for Transportation.

Consent to be photographed
to be photographed.

I grant permission to the above mentioned summer camp and Lanark Community Programs and its’ employees to take and use (including publish) for the purposes of instructions, promotion, FR website fundraising similiar purposes photographs, website, facebook ,films and videos of the of the above.

Please check the box and Enter your Full Name to indicate your consent to be photographed.
***Our Facebook page and website are accessible to the public  www.frprograms.weebly.com***

CONSENT TO RELEASE INFORMATION
I understand that any information collected or  shared will  remain confidential and be used for the sole benefit of the child.     
 
Name of Organization                                                       Contact Name and Phone
Please check the box and Enter your Full Name to indicate your consent to Release Information.
Camp T-shirt
CONDITION OF ENROLMENT FORM
you agree to be bound by the following conditions:
  1. The Supervisor at his/her sole discretion reserves the right to dismiss a child from the program when he/she deem this to be in the best interest of either the child, the children, or the program itself.  Following contact from the Camp Director or Assistant Director, it is the responsibility of the parent/guardian, or supporting organization, to quickly seek transportation and arrangements to remove the participant from camp.
     
  2. The above mentioned Day Camp and Lanark Community Programs, or its agents, will NOT be held responsible for any accidents, injuries, losses or damages that may occur as a result of participant involvement in the above mentioned Day Camp.  These activities may include community outings, bus trips and swimming.  As a parent/guardian, I will be notified of these trips or outings upon arrival to camp or through the camp=s weekly newsletter.
 
I have read and agree to all the conditions stated in the Conditions of Enrolment for my child to attend the
Please Check the box and Enter your Full Name to indicate you have Read and agree to all of the conditions of Enrollment for your Child to attend the Day Camp Program.