*All fields required.

Name and Date of Camp

Name of Camper

Birthdate:

Age:

Email:

Address:

Postal Code:

Phone:

Cell:

Any allergy information or special needs that we should be made aware of: physical, behavioral, special learning needs, allergies, asthma:

Physician's Name:

Emergency Contact:

Phone:

City:

Sex (Male or Female)

Campers are required to bring a water bottle, sun screen, insect repellant, sun hat, and a bagged lunch. Please clearly mark any personal belongings with a permanent felt pen, in case of duplicate belongings or in case something gets forgotten - we will then be able to return items to you. Thank you!

I, the parent or guardian of the above named participant, give my voluntary consent to his/her participation in Educational Adventure Camp activities and agree to all the conditions of enrollment in this camp. I authorize Educational Adventure staff to approve and obtain any and all medical attention and medical staff in the case of a medical emergency; with the understanding that all reasonable attempts have been made to consult with myself beforehand except in the case of minor illness and/or first aid where deemed appropriate; with the understanding that I will take responsibility for any additional expenses that may result from such services.

I release Educational Adventure Camps and its staff from any loss, personal injury, accident, misfortune or damage to the above named or his/her property, with the understanding that reasonable precautions shall be taken to ensure the health and safety of the above named. I understand that Educational Adventure Camps, and its staff reserve the right to dismiss a participant who is in their opinion a hazard to the safety and well-being of others, who appears to have rejected the reasonable guidelines of the activity.

I have read this waiver and accept the conditions of enrollment with the full knowledge that this form with my signature may be used as a legal document in any court of law.

Child's Name

Parent / Guardian:

Phone:

Date Signed:

If you have any questions, please contact Karen Dargatz by email: kdargatz@telusplanet.net or by phone (780) 962-3727. *Please include payment with your registration. Please make cheques payable to Educational Adventures.