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NAME:_____________________________ m / f
ADDRESS:__________________________________
AGE: ________ PHONE #: ___________________
HEALTH CARD #:___________________________
EMAIL:___________________________
EMERGENCY CONTACT & PHONE #:
__________________________________________
CONSENTING PARENT/GUARDIAN NAME:
__________________________________________
HEALTH CONCERNS/ALLERGIES ETC.:
__________________________________________
I, the undersigned, give permission for my child ________________________________to attend Extreme Zone Day Camp with Highlands Youth for Christ/Campus Life/The Door Youth Centre. I understand and accept full responsibility for my child's health insurance and/or care while away with the group, or if he or she becomes involved in an accident either travelling to or from any of the above events. I also understand and release Highlands Youth for Christ/Campus Life/The Door Youth Centre and its representatives who are in charge of this event of all or any legal actions or responsi-bilities that may occur due to an accident of any kind or injury to the child taking part. I do however give those in charge permission to do whatever is required to aid my child in receiving medical attention if necessary, and I have included his or her health card number, and hereby sign this consent form understanding the terms set out herein.
Photography Waiver: I will permit that photos/videos of my child(s)
be taken on this trip for promotional purposes, including posting
photos/clips on the YFC’s website. If you allow your child’s photo/clip
to be published:
I will allow my child’s photo to be used: Yes ___ No ___ SIGNATURE of CONSENTING PARENT/GUARDIAN: ____________________________________
Please check off what date you are interested in coming to Day Camp and fill out the permission form below. Please make cheques payable to “Highlands Youth for Christ”. PLEASE NOTE NO POST DATED CHEQUES, ALL WEEKS MUST BE PAID FOR IN ADVANCE
Dates:
July 12-14 ..................... $ 40.00 July 19-21 ..................... $ 40.00 July 26-28 ..................... $ 40.00 Aug. 2-4 ........................ $ 40.00 Aug. 9-11 ...................... $ 40.00 Aug. 16-18 .................... $ 40.00 Or pay for all 6 weeks ... $220.00
The Door Youth Centre
9 Centre Street
P.O. Box 21
Orangeville, ON
PERMISSION FORM
The Door: 519-938-8031
Fax: 519-941-5476
Email: [email protected]
LIKE US ON FACEBOOK!!!
Transforming a generation………. One life at a time
EXTREME ZONE
SUMMER DAY
CAMP 2016 For kids aged 10-13
Cost: $40.00 PER WEEK
for 3 days per week
OR 6 WEEKS FOR $240.00
highlands
EXTREME ZONE
SUMMER DAY
CAMP!
EXTREME ZONE SUMMER DAY CAMP
FOR AGES 10-13
Cost: $40.00 per week for 3 days or
6 weeks for $240 Tuesday, Wednesday, Thursday
Includes: One
SPECIAL EVENT TRIP each week
Time:
9:30am. - 4:00pm. (5 on Wednesday)
Pick up at 9:00 a.m.
*in Grand Valley at The Door
Camp will be held at:
THE DOOR YOUTH CENTRE 9 Centre Street - Orangeville
Also included: WEEKLY TRIPS SNACKS DRINKS FUN!
(bring a bag lunch)
DAY CAMP WILL BE SUPERVISED BY ADULT STAFF
AND VOLUNTEERS
PLEASE BRING: Sunscreen Running shoes Water bottle Bag lunch Good attitude
ALL ACTIVITIES WILL BE HELD AT THE DOOR IN ORANGEVILLE,
EXCEPT FOR THE WEEKLY DAY TRIPS
July 12-14: Beach Trip—July 13 July 19-21: Hiking—July 20
July 26-28: Bingeman’s —July 27
huge waterpark
Aug. 2-4: Beach—Aug 3
Aug 9-11: Scavenger Hunt—Aug 10
Aug 16-18: Grand Adventure—Aug 17
The Door Youth Centre
9 Centre Street
P.O. Box 21
Orangeville, ON
L9W 2Z5
The Door: 519-938-8031
Fax: 519-941-5476
Email: [email protected]
Shelburne: [email protected]
