Knox Day Camp Registration Form

St. James United Summer Camp Registration Form 2016
Summer Camps
July 11 -10 , 2016 (Spy Academy VBS), August 8th-12th 2016 (Superheroes VBS),
August 22-26th (Eco-Adventure)
8:30 am – 4:00 pm Ages 5 – 11
Child’s Name: _________________________________________ Age: _____ M / F
Parent/Guardian: ______________________________________________________
Daytime Phone #: ____________________________ Alt #: ___________________
Address: ______________________________________ Postal Code:___________
Email: ______________________________________________________________
Health Card # (optional): _______________________________________________
Allergies: ____________________________________________________________
Special notes: _________________________________________________________
Emergency Contact: ___________________________ Phone: __________________
Pick Up Authorization: (aside from parents and emergency contacts):
Name __________________________ Phone # ______________________________
Name __________________________ Phone # ______________________________
Name __________________________ Phone # ______________________________
Name __________________________ Phone # ______________________________
St James United Church. 221 Romaine Street, Peterborough, ON K9J 2C3
[email protected]
St. James United Summer Camp Registration Form 2016
My child would like to participate in the following weeks of camp (please check all that apply)
 July 11th-10th, 2016 (Spy Academy VBS) includes a trip to World Championship Martial Arts Centre,
Bowlerama, and Swimming at the YMCA.
 August 8th-12th 2016 (Superheroes VBS) includes trip to Millertown for Minigolf and Rock-climbing as well
as Swimming at the YMCA.
 August 22-26th (Eco-Adventure) includes a trip to the Ecology Park at Beavermead, as well as Swimming at
the YMCA.
I have paid/ will pay the following fees (please check all that apply)
 $100/child/week of camp
 I would like to inquire about receiving a subsidy.
Important Note: Fees are due at time of registration. Receipts will be issued upon request.
Camp Policies:
*Campers Possessions:
Please send the following items with your child daily:
o Peanut-free lunch & healthy snacks.
o Refillable water bottle. Please send it full; we can refill it at camp.
o Running shoes, sunscreen and a hat
Please do not send the following items with your child:
o Money.
o Toys, dolls or stuffed animals.
o Electronic devices.
o Medications
We have a lost and found box for the camp that is located at the camp entrance at the bottom of the stairs.
Please check there if your child is missing something. St James United Church is not responsible for any
personal items lost or stolen from church property.
*Photographic Release:
I hereby authorize St James United Church to use images or recordings of my child for activities and
promotional materials for the Church. In addition, I understand that these images could also be shared with
external media organizations, such as newspapers and television stations.
I understand that every precaution is taken to secure the safety of each child; however in case of an accident,
if I cannot be reached, I agree to allow the staff and volunteers of St. James to accompany my child to hospital
if necessary, until I can be there, and I agree to release St. James United Church from any liabilities. We offer
St James United Church. 221 Romaine Street, Peterborough, ON K9J 2C3
[email protected]
St. James United Summer Camp Registration Form 2016
some snacks at camp and making a snack is one of the activities in our camp rotation. If your child has any
allergies, please indicate that on the registration form.
*Off-site Activities:
Each day of camp that is sunny, the children will go to a park and splash pad beside St. James. One day per
camp, the children will travel to various locations by city bus and will spend the day there. I give permission for
my child to participate in these off-site activities. I also understand that these activities are weather
permitting and may be cancelled at any time.
Children must bring sunscreen to camp every day. This sunscreen needs to cream rather than spray/aerosol,
as the children will apply sunscreen inside and the spray sunscreen harms the floor. Should my child need
assistance in applying sunscreen, I give permission for the staff and volunteers at camp to assist him or her.

*Pickup & Drop off:
Camp doors open at 8:30 am. Camp closes at 4 pm. Please be prompt in picking your child up.
Only those people listed on the registration form as authorized to pick up a child from day camp will be able to
leave camp premises with a child. You may update the authorized list at any time by speaking with staff.
Notes will be accepted, but may also be confirmed by phone.
*Camp Dismissal:
A child may be sent home for any number of reasons including, but not limited to; illness; swearing; violent,
inappropriate or abusive behaviour; possession of drugs, alcohol or weapons; vandalism, theft, leaving group
or day camp grounds without permission; or noncompliance to rules and regulations of the Day Camp. If
called by camp staff I agree to come and pick up my child immediately.
*Complaints or Concerns:
Any complaints or concerns about the day camp, including programming, child supervision, and discipline
techniques can and should be discussed with Raquael Jones, the Child, Youth & Family Program Director at
742-2222 or by emailing [email protected]
I have read through and agree to abide by the above St James United Church Camp polices for 2016. I
understand that any violation of these terms may result in immediate dismissal from camp.
(Parent/Guardian signature)
St James United Church. 221 Romaine Street, Peterborough, ON K9J 2C3
[email protected]