Inquiry Form, Website Please complete the form to receive more information and schedule a school tour. 2020 CAMP HORIZONChild's Name* First Last Grade*Sex*MaleFemaleDate of birth* Date Format: MM slash DD slash YYYY PLEASE CHECK THE WEEKS & TIME SLOT THAT YOU WOULD LIKE TO REGISTER YOUR CHILD* Aug 4 - Aug 7 : 9:00 12:00 - $165 Aug 10 - Aug 14 : 9:00 12:00 - $165 Aug 17 - Aug 21 : 9:00 12:00 - $165 Aug 24 - Aug 28 : 9:00 12:00 - $165 In order to be allowed into the program: Students need to have turned 3 years by July 1st 2020- MUST BE FULLY TOILET TRAINED.**No spots will be reserved without a tuition fee payment** ✓ Summer tuition must be paid in advance (full amount) before the child starts camp. ✓ No reductions for absenteeism & Statutory holidays or short term COVID absence. ✓ All fees are non-refundable. ✓ Registration/special events fee to accompany this form $30.00 (non-refundable). This fee will help to cover all other additional costs. ✓ First come first served basis. If the week(s) you are requesting are full, we will provide you with an alternative. STUDENT & FAMILIY INFORMATIONMother/Guardian InformationMother/Guardian Name* First Last House Address* Street Address City State / Province / Region ZIP / Postal Code Home PhoneCell Phone*Work PhoneEmail* Father/Guardian InformationFather/Guardian Name First Last House Address Same as Mother/Guardian Street Address City State / Province / Region ZIP / Postal Code Home PhoneCell PhoneWork PhoneEmail Emergency ContactName* First Last Relationship to child*Home PhoneCell Phone*Work PhoneEmail Persons authorized to pick my child up Click ⊕ sign to add moreEmergency ReleaseConsent to Emergency First Aid & Transportation:* I hereby give permission that my child listed above may be given emergency treatment by Camp HORIZON staff member as deemed necessary. I also give permission for my child to be transported by car or ambulance to an emergency center for treatment, and agree to hold Camp HORIZON and its employees harmless. Any costs associated to medical care and treatment (including ambulance fees) will be the responsibility of the parent/guardian. Signature*Date Date Format: MM slash DD slash YYYY Medications & Health Information:Medication required (epi - pen, puffer, etc.)?*YesNoName of medication* Please complete medication form Relevant health information (Medical condition )*Any Allergies?*YesNoAllergies (please list)*Alberta Health Care Number*Doctors Name*Consent to Medical Care and TreatmentPlease check the box beside the statement.* In the event that I cannot be contacted immediately, medical of surgical treatment can be administered to my child in the case of an accident or emergency, as prescribed by a treating physician, and I hold Camp HORIZON and its employees not negligent. Any costs associated with medical care and treatment (including ambulance fees) will be the responsibility of the parent/guardian. Signature*Date Date Format: MM slash DD slash YYYY Medication AdministrationPlease check the box beside the statement.* I understand that Camp HORIZON can only administer medication when the Parent/Guardian has completed a medication administration form. I understand that Camp HORIZON can only administer prescribed medications .I understand that Camp HORIZON will administer medication according to the directions on the label. I understand Camp HORIZON will only administer medication provided in the original container. I understand that when ongoing medication is required (i.e. Asthma medication or Epi-Pen) an Emergency Medication Administration form must be completed by the Parent/Guardian (and doctor, if requested). Signature*Date Date Format: MM slash DD slash YYYY Field Trip PermissionPlease check the box beside the statement.* I hereby permit that my child listed above can participate in spontaneous field trips to the local park or walks in the neighborhood that would involve taking the child outside of the camp premises for his/her benefit in attendance at this camp. If major field trips are planned, a separate permission form will be provided in advance for parents/guardians to sign. This form will include the date, transportation and supervision arrangements of the activity. Signature*Date Date Format: MM slash DD slash YYYY Photo & Video PermissionPlease check the box beside the statement.* Camp HORIZON uses photo documentation in order to track your child’s activities throughout the summer. We also use these photos for documentation panels throughout the camp location. Occasionally we would like to use photos on our social media and website, as well as including photos in our camp bulletin that will go home to enrolled families. Signature*Date Date Format: MM slash DD slash YYYY If there are custody orders please upload a copy here Drop files here or List
