2017 SUMMER CAMPS APPLICATION

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Martina Barnett
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1 Participant's Name: Please check the appropriate boxes to identify which sessions you wish to attend. HOLIDAY WEEKS Please see website for details and pricing. *Camps are closed July 3rd for Canada Day and the Monday August 7th Civic Holiday, running at a 4-day pro-rated price. ARTS & MEDIA CAMPS (AGES 7-15) Art and Digital Photography Jr $370 Fashion Design Jr $390 Visual Arts Jr $390 Music & Beat Production Jr $370 Acro (Rhythm Gymnastics) 7-12 $370 Cake Decorating & Baking 7-12 $390 Cartoons and Comics 7-12 $370 Theatre Arts 7-14 $370 Dance 7-14 $370 Visual Arts Sr $390 Music & Beat Production Sr $370 Prop Making $390 Adventures in Film Making $370 Arts & Digital Photography Sr $370 Chefs in Training $390 Creative Writing $370 Fashion Design Sr $390 Made By Me $390 Digital Interior Design $370 Digital Cartooning $370 Film Making (Special Effects) $370 SCIENCE & SUCCESS CAMPS (AGES 7-15) Mad for Math Jr $370 Video Game Design Jr $370 LEGO Robotics Jr $370 Space and Beyond 7-10 $370 World Explorers 7-10 $370 Wacky Science Jr. Extra Sessions 7-10 $370 Mad for Math Sr $370 Coding for Kids $370 3D Digital Architecture Design $370 Doctors In Training $460 Entrepreneur Camp $370 LEGO Robotics Sr $370 Money Smarts 4 Kids $370 Money Smarts 4 Kids Advanced $370 VEX Robotics $390 Video Game Design Sr $370 Video Game Design Advanced $370 Forensics $390 Wacky Science Sr. Extra Sessions $390 Age 5-day camp cost (Except for week 1 and week 6) July 4-7* (week 1) July (week 2) July (week 3) July (week 4) July 31-August 4 (week 5) August 8-11* (week 6) August (week 7) August (week 8) August 28-Sept.1 (week 9) Page 1 of 6

2 Please check the appropriate boxes to identify which sessions you wish to attend. HOLIDAY WEEKS Please see website for details and pricing. *Camps are closed July 3rd for Canada Day and the Monday August 7th Civic Holiday, running at a 4-day pro-rated price. SPORTS & ADVENTURE CAMPS (AGES 7-15) Golf Jr $390 Exploring the Sports Jr $370 Introduction to Martial Arts 7-10 $370 Basketball 7-15 $370 Soccer 7-15 $370 Tennis 7-15 $390 Cheerleading Camp 7-15 $370 Global Sports Challenge 7-15 $370 Try-Triathlon (p.m.) 7-15 $270 Adventure Pursuits (Canoeing & Rock Climbing) $405 Adventure Pursuits Plus (Canoeing, Rock Climbing, S'Up, Rattlesnake Point) $460 Advanced Soccer $390 Exploring the Sports Sr $370 Extreme Adventure Challenge $390 Flag Football $370 Golf Sr $390 Performance Swim (a.m.) $270 Trip Tastic $490 Sailing $575 Survival Skills $390 Volleyball $370 LEADERSHIP CAMP (AGES 12-17) Junior Leader $450 Senior Leader (Standard First Aid + CPR-C) $475 Age 5-day camp cost (Except for week 1 and week 6) July 4-7* (week 1) July (week 2) July (week 3) July (week 4) July 31-August 4 (week 5) August 8-11* (week 6) August (week 7) August (week 8) August 28-Sept.1 (week 9) Please check the appropriate boxes to identify which sessions you wish to attend. HOLIDAY WEEKS Please see website for details and pricing. *Camps are closed July 3rd for Canada Day and the Monday August 7th Civic Holiday, running at a 4-day pro-rated price. EARLY DISCOVERY CAMPS (AGES 4-7) Age 5-day camp cost (Except for week 1 and week 6) July 4-7*(week 1) The Great Outdoors July (week 2) Cave Explorers July (week 3) Fairy Tales July (week 4) Secret Superpowers July 31-August 4 (week 5) Holiday Celebrations August 8-11* (week 6) Fun with Maps WEEKLY THEMES Arts Discovery 4-7 $370 Camp & Sports Discovery (Half Day a.m.) 4-7 $270 Camp & Sports Discovery Jr. 4-7 $370 Camp & Sports Discovery Sr. 4-7 $370 Nature & Science Discovery 4-7 $370 August (week 7) Mystery Hunters August (week 8) Around the World August 28-Sept.1 (week 9) Time Travelers Page 2 of 6

3 2017 EARLY DISCOVERY CAMPS WEEKLY THEME DETAILS Week 1: The Great Outdoors From camp fire sing-a-longs to tent building competitions to going on hikes, campers will surely get a taste of the great outdoors this week and will have the camp badge to prove it! Week 2: Cave Explorers You will never know what is in a cave until you go in there. This week, campers will get into the nooks and crannies of the Appleby campus to find creatures that they may or may not be familiar with. Don t worry, we will have flashlights for our fun adventure! Week 3: Fairy Tales Once upon a time at Appleby Camps, there was a week of fun with a fairy tales theme! Through timeless stories like Jack and the Beanstalk and Little Red Riding Hood, campers learn from tall tales. Be ready to run in a game of Giants, Wizards and Elves, make the crown or steal the treasure from a dragon! Week 4: Secret Superpowers Do you have secret superpowers? This week, campers can use their special abilities in fun activities and puzzles. There will be opportunities to test out strong, flexible muscles, superpower breath and more! Don t miss out on your chance to discover your inner talents! Week 5: Holiday Celebrations Join us for a week-long celebration of all your favourite holidays. Valentine s Day, Christmas in July and even camp-wide trick-or-treating! Don't forget your costume! Week 6: Fun with Maps What s your favourite place to go with friends and family? Make your own community at Appleby and discover new places you can go! This week, campers get to plan and map out stores, buildings, parks...or wherever your imagination takes you. Week 7: Mystery Hunters Things keep going missing at Appleby. This week, we need help from campers to find precious missing items and solve secret codes. If you are a brave camper who likes to dig deep and put clues together, this week is for you. Put your thinking hats on! Week 8: Around the World Create a Lego Eifel Tower, a Mexican Mask, and then head to Europe to play Spain, Spoon, Spaghetti! Join in a fun game of UK toilet paper football or get wrapped up like an Egyptian mummy! Week 9: Time Travelers From dinosaurs to robots, campers get to use their imagination to picture what happened in the past or what may happen in the future. Join us this week for adventures across time, and see you back in the past or to the future! Please check the appropriate boxes to identify which sessions you wish to attend. HOLIDAY WEEKS Please see website for details and pricing. *Camps are closed July 3rd for Canada Day and the Monday August 7th Civic Holiday, running at a 4-day pro-rated price. Age 5-day camp cost (Except for week 1 and week 6) July 4-7* (week 1) July (week 2) July (week 3) July (week 4) July 31-August 4 (week 5) August 8-11* (week 6) August (week 7) August (week 8) August 28-Sept.1 (week 9) BEFORE & AFTER CARE CAMP OPTIONS (AGES 4-17) Before & After Care is available daily for all age groups. You must pre-register for this service and participants will be entertained with a variety of activities organized by our fabulous instructors daily from as early as 7:30 a.m. until our extended 6:00 p.m. pick-up time. Snack is also provided daily in the morning and afternoon. Late fees will apply when participants are picked up after 6:00 p.m. Weekly Before Camp Care (7:30 9:00 a.m.) 4-17 $25 Weekly After Camp Care (3:30 6:00 p.m.) 4-17 $55 Weekly Before & After Camp Care Combined 4-17 $65 ROUND TRIP BUSING (AGES 4-17) Burlington Mall 4-17 $65 Erin Mills Towncentre 4-17 $65 Glen Abbey Community Centre 4-17 $65 Iroquois Ridge Community Centre 4-17 $65 Maple Grove Arena 4-17 $65 Milton Sports Centre 4-17 $65 River Oaks Community Centre 4-17 $65 Appleby Camps is now offering round trip, point-to-point busing for campers in the Oakville area. Morning bus drop-off will be between 8:15-8:30 a.m. while afternoon pick-up will be between 4:15-4:30 p.m. You must register for busing at least one week prior to the start of the camp week, and choose the location best suited for your family. Every bus will arrive with a bus captain already on board to check-in your camper, and ensure a safe and fun journey to and from camp. *NOTE: In order to maintain efficiency with our busing program, we cannot accept transportation requests. Page 3 of 6

4 PARENT/GUARDIAN #1: PARENT/GUARDIAN #2: Salutation: Mr. Mrs. Ms. Dr. Other: Relationship: Parent Legal Guardian Other: Last Name: First Name: Salutation: Mr. Mrs. Ms. Dr. Other: Relationship: Parent Legal Guardian Other: Last Name: First Name: Home Phone: ( ) Home Phone: ( ) Business Phone: ( ) Business Phone: ( ) Cell Phone: ( ) Cell Phone: ( ) PARTICIPANT MAILING ADDRESS: Family Parent/Guardian #1 Parent/Guardian #2 Street: EMERGENCY CONTACT: Name: Relationship to Participant: City: Home Phone: ( ) Province: Cell Phone: ( ) Postal Code: Business Phone: ( ) FAMILY INFORMATION Nationality: Canadian American Other: Parents are: Married/Common Law Separated Single Divorced Participant lives with: Both Parents Mother Only Father Only Guardian Grandparents Are there any restrictions on either parents' or legal guardians' access/custody? Yes No If YES, please detail: AUTHORIZED PICK UP LIST In addition to parents/guardians, and the mentioned Emergency Contact, please list the names of any other local emergency contacts who can pick up your participant (nanny, grandparents, neighbours, step parents, etc.) from Camp: NAME RELATIONSHIP TO PARTICIPANT CONTACT PHONE NUMBER SELF SIGN OUT With parent/guardian permission, campers ages are able to sign themselves out of camp. Would you like to authorize this permission? Yes No Page 4 of 6

5 PARTICIPANT INFORMATION Last Name: First Name: T-Shirt Size (circle): Child S M L Adult S M L XL Sex: M F Age (as of June 2017): Birthdate (MM/DD/YYYY): Nationality: Canadian American Other:* English Level: Fluent Advanced Intermediate Beginner welcomes campers from all nationalities and language groups. To allow for the safest and most positive experience for all campers, we offer specific weekly programs to non-native English speakers, who are required to meet a certain level of proficiency in their English-speaking ability. To ensure that we are able to offer a genuine camp experience to all participants, the number of students admitted to each program is limited. All applications will be reviewed prior to confirmation. Agents representing international campers are asked to please contact CEC@appleby.on.ca prior to application.* * An administrative fee of $125/week will be charged for participating campers who do not hold Canadian citizenship. HEALTH CERTIFICATION All participants must have health insurance. Ontario residents are covered through OHIP, and should indicate their number below. If the participant is not a resident of Ontario, please indicate the insurance company and policy number below. By signing the bottom of the form, the parent/guardian indicates the applicant is in good health. Canadian Health Card Number: Insurance Company (non-residents): Please indicate any health concerns (allergies, medical conditions, medication): Is participant a Canadian Resident? Y N Policy Number: Does this participant have any food allergies or dietary restrictions? If so, please indicate and to what severity: cannot guarantee an allergy-free environment. All campers must be able to identify their own allergies and carry the needed medication for treatment. PROGRAM SUPPORT (Please indicate any concerns to aid our staff in providing the best care for participants (behavioural, emotional, etc.) PARTICIPANT REQUESTS We will do our best to accommodate friend/family requests to be in the same group. Please list names below: 1) 2) 3) 4) CAMP PROGRAM FEE INFORMATION Camp Program Fees include supervision by Appleby Camps staff, all of who are certified in Standard First Aid and CPR-C, have a police check and are extensively trained in Appleby s camp training program. All programs are led by experienced teachers and/or specially accredited head instructors. Instructor to camper ratios are 1:5 for the Discovery Camps (ages 4-7) and for all other camps the maximum instructor to camper ratio is 1:9. Fees include a nutritious lunch with hot selections for all full-day programs which run from 9:00 a.m. to 3:30 p.m. and recreational swim time in the indoor pool. Appleby s scenic 60-acre lakeside campus offers outstanding academic, art and athletics facilities, both indoor and outdoor, for all its camp programs. CHILDREN'S FITNESS & ARTS TAX CREDIT The children s fitness tax credit and children s art credit is available for all child and youth recreational programs that meet the criteria established by the CRA. For more information, please visit Page 5 of 6

6 WAIVER AND CONSENT Privacy Policy: Personal information collected for the Summer Camp will be used and held solely by. Information is collected for the operation of the camp which includes safety and emergency purposes, and for future correspondence with camp participants, which may include information about relevant upcoming events. Conduct: Campers are expected to demonstrate basic respect for the dignity and rights of others. The Director reserves the right to implement an established process and/or suspend and/or terminate the stay of any camper, who violates the camper Code of Conduct based on the following guidelines: zero tolerance of physical or psychological abuse/bullying; lack of respect for camp property and the property of others; behaviour that requires supervision beyond a reasonable level or behaviour deemed inappropriate by Camp staff. Refund Policy: Full refunds will be issued for any cancellation received 30 days prior to the first day of attendance of camp. For cancellations received 14 days prior to the first day of attendance of camp refunds will be subject to a $100 administration fee. Requests for cancellation received within 14 days of camp start date are non-refundable (full registration fee) unless a medical certificate accompanies the request. Refunds will not be granted for inclement weather or for days of camp not attended. Camps will do everything possible to avoid program cancellations; however we reserve the right to cancel a session of camp if the minimum enrollment is not met. In this circumstance, we will accommodate your child in an alternate program/alternate week or we will provide you a full refund at your discretion. Media Waiver: I hereby authorize the inclusion of my child in camp photographs and video and understand that this media will be used on Appleby s web-site, social media, hosted photo galleries and other sites related to school and camp program activities. Photos and videos may also be taken at any time for print or online promotional purposes but participants will not be identified. Concerns over this policy should be reported directly to Jenny Wyatt, 's Director of Camps at campphotos@appleby.on.ca. Medical Waiver: I, the undersigned, hereby authorize or anyone acting on its behalf, to acquire necessary medical aid that may be required as a result of any accident or injury sustained by my child. I hereby indemnify and save harmless from any and all actions, claims and demands for damages, loss or injury, however arising, which hereafter may have been sustained by my child while participating in the Summer Camps. If information submitted on this form is false, Appleby Camps has the right to remove the participant from the program. I have read and agree to the above Parent/Guardian #1 or Parent/Guardian #2 Signature Date STAY CONNECTED - STAY INFORMED As per the Government of Canada s anti-spam legislation (CASL) Appleby Camps requires your consent in order to continue sending you information electronically about your child s camp program. By checking yes, you will continue to receive information regarding: urgent updates, direct access to photo galleries, special invitations, letters from the Camp Director and early registration notifications. Should you select no your name will be removed from our mailing list. Yes, keep me connected No, I do not wish to stay connected PAYMENT INFORMATION (Payment is due in full upon registration) Participant's Name: Total Payable: $ MasterCard Visa AMEX Card Number: Name on Card: (Cheques payable to ) Expiry Date (MM/YYYY): Security Code on Back of Card: Signature: If paying by credit card, you may register by fax at or online at Financial information collected will only be used by and shared with the appropriate credit card company. Please fill out and return this form to: Appleby Summer Camps 540 Lakeshore Road West, Oakville, Ontario L6K 3P1 Phone: ext. 113 Fax: camps@appleby.on.ca Web: (to register online). Contact us about team or large group discounts. Page 6 of 6

7 2017 SUMMER CAMPS MEDICAL INFORMATION Please print clearly on the form below, scan and it to APPLICANT INFORMATION Participant Last Name: Date of Birth (mm/dd/yyyy): MEDICAL INFORMATION Does your participant have Provincial Health Coverage in Canada? Yes No If yes, in which Province? Version Code (if any): Participant First Name: Sex: M F Provincial Health Card Number: Health Card Expiry (if any): Medical History: Please fill in the information required as completely as possible. does not undertake to monitor the health of its participants. This is the responsibility of the parents/guardians. However, the following information will be of assistance to in providing emergency medical care, should such care be necessary. Is participant anaphylactic? Yes No Please note that all participants with a diagnosis of being anaphylactic must carry a labelled EpiPen. Labelling must be in English. What is your participant anaphylactic to? (please check all that apply) Eggs Soy Wheat Latex Peanuts Fish Dairy Insect Bites and Stings. Specify: Treenuts. Specify: Shellfish. Specify: Medications. Specify: Other. Specify: Does your participant have an EpiPen? Yes No Does your participant have any allergies? Yes No What is your participant allergic to and what is the severity? (please check all that apply) Environmental. Specify: Dust Mites Insect Bites. Specify: Pets. Specify: Food. Specify: Other. Specify: What treatment, if any, does your participant need if exposed to the allergen? Does your participant have asthma? Yes No Please note if your participant has asthma, you will be contacted and asked to complete an asthma action plan. Does your participant have any dietary restrictions? Yes No Please note that due to kitchen limitations we are unable to accommodate Kosher. While we are a 'nut aware' campus, we cannot guarantee that we are a 'nut free' campus. What are your participant's dietary restrictions? (please check all that apply) Vegetarian Vegan Halal Gluten-Free Lactose Intolerant Other: Has your participant had any of the following: Kidney Disease Bleeding Disorder Heart Condition Diabetes Epilepsy/Seizures Depression Other If you have checked any of the above, please explain: Page 1 of 2

8 2017 SUMMER CAMPS MEDICAL INFORMATION Please list ALL medications (including prescription and over the counter medication) your participant will be taking while attending Camps and explain why they are prescribed for your participant. Are there any other major health concerns (medical conditions, medications, past hospitalization, mental health, head injuries, concussions, etc.) your participant has or has had that we should be aware of to best support them while here at : Acknowledgement (must be answered by all parents/legal guardians): The medical information I have provided is correct and complete, in every respect, to the best of my knowledge. I agree to notify Camps if any of the above information should change, to my knowledge, after the date hereof, or if I should discover that any information is incorrect. I agree to notify as soon as reasonably possible, of any medical development in the health of the participant, knowledge of which woud be useful to in the running of its programs, and interest of the participant. Signature: Relationship to Participant: Date: MEDICAL WAIVER I hereby authorize and/or an nurse, teacher, administrator or other employee (collectively, the "College") to provide this participant with routine first aid and authorized medication. I further understand and agree that, in the event of an emergency, the College may provide, administer, obtain and/or authorize medical care for the participant. I understand that in the event of a serious medical problem or emergency, the College will make best efforts to contact me as soon as possible. I understand and agree that this authorization shall remain in effect for the time of the program at. I hereby release and indemnify the College from any and all claims for damages arising from any injury to the participant as a result of any accident, illness, injury or for any other reason arising from participation in school activities. I hereby acknowledge that any medical treatment will be performed in the Province of Ontario, and that the courts of the Province of Ontario shall have exclusive and preferential jurisdiction to entertain any complaint, demand, claim, proceeding or cause of action arising out of the medical treatment. I hereby agree that if I commence any such legal proceedings, I will do so only in the Province of Ontario, and hereby irrevocably submit to the exclusive and preferential jurisdiction of the courts of the Province of Ontario. I hereby agree that the resolution of any and all disputes relating to or arising from this agreement and/or the interpretation thereof shall be governed by and construed in accordance with the laws of Ontario and the laws of Canada applicable therein. Parent/Guardian Signature Witness Signature Date Parent/Guardian Signature Witness Signature Date Please fill out and return this form to: Appleby Summer Camps 540 Lakeshore Road West, Oakville, Ontario L6K 3P1 Phone: ext. 113 Fax: camps@appleby.on.ca Web: (to register online). Contact us about team or large group discounts. Page 2 of 2

Arts & Media Camps (ages 7-15)

Participant's Name: Arts & Media Camps (ages 7-15) Art and Digital Photography Jr. 7-10 $350 Music & Beat Production 7-10 $350 Acro (Rhythm Gymnastics) 7-12 $350 Cake Decorating & Baking 7-12 $360 Cartoons