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Pick location *

Pick package *

Mother's Name *

Mother's Phone Number *

Mother's Email Address *

Father's Name *

Father's Phone Number *

Father's Email Address *

Address *

Emergency Contact - Name *

Emergency Contact - Relationship *

Emergency Contact - Phone Number *

Authorization for Pick-Up: *

Besides mom and dad, who has authorization to pick up your child(ren) from our summer camp?

1st Child - Name of Child *

1st Child - Birthday *

1st Child - Health Card No. *

1st Child - Gender *

Male
Female

1st Child - Grade entering in September 2024 *

1st Child - Allergies/Medical Conditions *

1st Child - Any other special concerns we should know about?

1st Child - Would child like to be in a group with friend/relative? If so, state the Name and Grade of friend/relative.

2nd Child - Name of Child

2nd Child - Birthday

2nd Child - Health Card No.

2nd Child - Gender

Male
Female

2nd Child - Grade entering in September 2024

2nd Child - Allergies/Medical Conditions

2nd Child - Any other special concerns we should know about?

2nd Child - Would child like to be in a group with friend/relative? If so, state the Name and Grade of friend/relative.

3rd Child- Name of Child

3rd Child - Birthday

3rd Child - Health Card No.

3rd Child - Gender

Male
Female

3rd Child - Grade entering in September 2024

3rd Child - Allergies/Medical Conditions

3rd Child - Any other special concerns we should know about?

3rd Child - Would child like to be in a group with friend/relative? If so, state the Name and Grade of friend/relative.

Terms and Services *

Click to Agree to terms and services below

PHOTO RELEASE FORM: I hereby permit the reproduction or display of photographs/film/audio recording of my child(ren) for current and future Gill Summer Camp purposes including advertising.

MEDICAL CONSENT STATEMENT: I have provided Gill Summer Camp with all the necessary medical information and I can be reached at the number(s) listed. I authorize Gill Summer Camp Inc. staff to administer first aid to my child(ren) in an emergency as deemed appropriate by the attending physician(s).

CONSENT FORM: I agree that as a participant in Gill Summer Camp my child(ren) will participate in activities in an elementary school as well as other locations. I agree that the choice to participate brings with it the assumptions of those risks and results, which are part of these activities. I agree that Gill Summer Camp, Peel Board of Education and Dufferin-Peel Catholic School Board and their trustees, officers, directors, employees, agents and independent contractors shall not be liable for any injury to my child(ren) or loss or damage to my child(ren)’s personal property arising from, or in any way resulting from my child(ren)’s participation in these activities.

REFUND POLICY: There will be no refund issued for missed days within a registered week. If a full week is missed due to illness a doctor’s note must be provided for refund.

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