If you are interested in the councilor in training program (CIT) please forward all names/questions to Lea at leapollock@gmail.com

 
Parent/Guardian Name:___________________________________
City Address:_______________________

Postal Code:____________ City Phone:________________
E-Mail:________________________________

Beach Address:__________________________
Phone:________________Cell:_________________

Emergency contact at Beach:____________________ Phone/Cell:________________

1. Child’s Name:_________________________ Age:______ DOB:_________
MHSC # ( 6 digit):___________

PHIN (9 digit):____________________ Grade completed____________
Dates at Camp:____________________

Health or behavior problems WBDC staff should be aware of:_________________________________________________________________
 
Please check off which week child #1 is attending. Please indicate if your child is staying for lunch at camp:

__ July 5th - 9th	pre paid ____	paid on site____
__ July 12th - 16th	pre paid ____	paid on site____
__ July 19th - 23rd	pre paid ____	paid on site____
__ July 26th - 30th	pre paid ____	paid on site____
__ August 3rd  - 6th	pre paid ____	paid on site____
__ August 9th - 13th	pre paid ____	paid on site____
__ August 16th - 20th	pre paid ____	paid on site____

2.  Child’s Name:_________________________ Age:______ DOB:_________
MHSC # ( 6 digit):___________

PHIN (9 digit):____________________ Grade completed____________
Dates at Camp:____________________

Health or behavior problems WBDC staff should be aware of:_________________________________________________________________
 
Please check off which week child #1 is attending. Please indicate if your child is staying for lunch at camp:

 

__ July 5th - 9th	pre paid ____	paid on site____
__ July 12th - 16th	pre paid ____	paid on site____
__ July 19th - 23rd	pre paid ____	paid on site____
__ July 26th - 30th	pre paid ____	paid on site____
__ August 3rd  - 6th	pre paid ____	paid on site____
__ August 9th - 13th	pre paid ____	paid on site____
__ August 16th - 20th	pre paid ____	paid on site____

 

 

 

   

 






Winnipeg Beach Day Camp – Release & Waiver
 
Release and Waiver for _____________________  and ____________________(children’s names, PRINT) I understand that participation in outdoor camp activities involves potential risk to my child (children) and I assume that risk on my child s (children's) behalf. Acknowledging this fact, and in consideration of you accepting my child’s (children's) registration for any and all sessions attended by my child in the 2010 camp season, I hereby for myself, my heirs, executors, administrators or any one else who may be entitled to claim on my or my child’s (children's) behalf, covenant not to sue, and hereby waive, release and discharge the Winnipeg Beach Day Camp Inc. and its officers and directors and all their agents, employees, assigns or anyone else acting for or of any kind or nature whatsoever arising out of, or in the course of my child’s (children's) participation in the camp, other than a result of gross negligence of officers, directors or employees of the camp. This release and Waiver extends to all claims of every kind of nature whatsoever, foreseen and unforeseen, known or unknown. I acknowledge having read this waiver and by signing below I am stating that I understand and accept its terms and conditions. 

Signature of Parent/Guardian ________________________________________
Date ________________
 


By signing below, I agree to allow my child's/ children's picture(s) to be featured in this or future editions of the Winnipeg Beach Day Camp website, or other such advertising for the camp. If I do not sign, I am not providing such permission.


Signature of Parent/Guardian _______________________________________
Date _________________