SuperKids Summer Day Camps Registration Form 2022

Gender (required)
MaleFemale

Street address (required)

City (required)

Province (required)

Postal Code (required)

Date of Birth (YYYY-MM-DD) (required)

Height (ft and in) (required)

Weight (lbs) (required)

Age (required)
678910111213

T-Shirt Size (required)
Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult X-LargeAdult XX-Large

Has the child attended SuperKids before?
YesNo

Can the child swim in water over their head?
YesNo

Does this child have any siblings registering for camp? (required)
YesNo

If yes, please list their full names

MEDICAL INFORMATION

Name of Doctor (required)

Doctor's Phone Number (required)

BC Care Card # (required)

Does the child have any allergies? (required)
YesNo

If yes, what are they and what is the child's reaction?

Does the child have any dietary needs or restrictions? (required)
YesNo

If yes, what are they?

Does the child have any other medical conditions, behavioural, or emotional concerns? (required)
YesNo

Please explain all medical conditions, behavioural, or emotional concerns, and symptoms

List all medications the child takes between 10 and 3 *Epi Pen must be brought if needed* (one per line)

I grant the designated LEADER permission to give my child over-the-counter medications if necessary (required)
YesNo

Parent/Guardian Initials (required)

CONTACT INFORMATION

Parent/Guardian First & Last Name (required)

Phone Number (required)

Email address (required)

Emergency Contact #1 Full Name (first and last) (required)

Phone Number (required)

Emergency Contact #2 Full Name (first and last) (required)

Phone Number (required)

PLEASE READ CAREFULLY AND SIGN BELOW TO INDICATE YOUR ACCEPTANCE

MEDICAL RELEASE:
I authorize the administration of any first aid treatment necessary at SuperKids Summer Day Camps for my child. In the case of a medical emergency, I authorize my child to be transported by designated leaders or arrange for transportation to the nearest medical or hospital facility. In such an emergency I hereby give permission to the physician involved to secure proper treatment for my child. In the event extraordinary transportation or medical treatment is required, I agree that Extreme Outreach cannot accept the financial responsibility. I expect to be contacted as soon as possible.

LIABILITY WAIVER:
I understand that Extreme Outreach is a Christian organization and that my child may receive Bible teaching at SuperKids Summer Day Camps. Extreme Outreach reserves the right to dismiss a child who in their opinion is a hazard to the safety and the rights of others, or who appears to have rejected the camp rules as directed by the designated camp leaders. A child who must be sent home due to disciplinary action or homesickness must be picked up by a parent(s) or designated emergency contact. I am confident that Extreme Outreach staff will do their best to give my child the necessary support and supervision needed and I understand that the safety and health rules will be observed. To the best of my knowledge, my child is in good health and physically, emotionally, and socially able to participate in all activities. I give my child permission to participate in all activities. If my child is not physically, emotionally, or socially able to participate in all activities, I understand that Extreme Outreach does not have the people for one on one with my child and they may be unable to attend. I hereby release Extreme Outreach Society and its personnel from all claims and damages arising from any accidents or injury caused by my child’s participation in the program or by any transportation to and from all locations. Extreme Outreach is not responsible for lost, stolen, or damaged items during my child’s participation. I agree that photos or videos of my child taken at SuperKids may be used in future Extreme Outreach and/or SuperKids promotional material. If I am not in agreement with this, I will give written notice to Extreme Outreach that the photos and videos are not be used for this purpose. The parent/guardian submitting this application are those having legal custody over the child. Conditions of custody, if applicable, will be fully communicated in writing to Extreme Outreach including a photocopy of the section of any court order referring to the visitation rights.

APPLICANT'S STATEMENT

I understand & agree

Parent/Guardian Initials (required)

Date (YYYY-MM-DD) (required)

Please remember the following day camp days:
July 13-15 for Ages 6-13