Family Information Form – Allan Brooks Nature Centre

Camp Children

Please complete this form to provide us with more information about your child(ren) attending our Nature Summer Camp!

General Information
Parent, Guardian, or Caregiver (As well as those approved to pick up child(ren) from camp)*
Full Name Phone Number Email Address Relation

Please list the person who purchased the summer camp tickets first, followed by any other parent, guardians, or caregivers who are approved to pick up your children from camp. This field is required.
Children Coming to Camp*
Child Name (full) Age Important Information Provincial Health Card Number

Please click the plus symbol to add a row for each of your children that you are bringing to camp. The important information field is for allergies, medical conditions, or any other child-specific information. This field is required.
Emergency Contact (Use + symbol to add multiple)*
Full Name Relation Cell Phone Other Phone (work, home, etc)

Please list two contacts in this area. This field is required.
Assumption of Risk
Assumption of Risk*
I consent to the following terms
(each a “Minor” and collectively, the “Minors”).
1. ASSUMPTION OF RISKS. I am aware that participation in activities, events or services provided,
  arranged or organized by Allan Brooks Nature Centre (“Activities”) involves inherent risks, dangers and hazards, including potential property damage and personal injury. I hereby irrevocably and unconditionally accept and assume, on behalf of myself and the Minor(s), all such risks, dangers and hazards, including property damage and personal injury, in connection with the participation of the Minor(s) in the Activities. I confirm that I have disclosed all relevant information about the allergies and medical conditions of the Minor(s) to ABNC.
2. RELEASE OF LIABILITY. I hereby, irrevocably and unconditionally release and forever discharge, on behalf of myself and the Minor(s), Allan Brooks Nature Centre and its directors, officers, employees, agents, volunteers, independent contractors, representatives, successors and assigns (collectively, “ABNC”) from any and all actions, causes of action, claims, demands, obligations, liabilities, losses, expenses, costs and damages, whether absolute or contingent and of any nature whatsoever, which I and/or any Minor, now has or hereafter can, shall or may have, arising, directly or indirectly, out of or in connection with the participation of the Minor(s) in the Activities, including in respect of negligence, breach of contract, breach of any statutory or other duty of care or the failure on the part of ABNC to take reasonable steps to safeguard or protect the Minor(s).
3. GENERAL. I expressly acknowledge and agree that this Release is intended to bind me, any other parent, guardian or legal representative of each Minor, and each Minor and be binding upon each of our heirs, administrators, assigns and representatives in the event of death or incapacity. I, the undersigned parent and/or legal guardian of the Minor(s), affirm that I am freely signing this Release. I have read this Release and fully understand that by signing this Release I am giving up legal rights and/or remedies which may otherwise be available to me and the Minor(s) in respect of any losses that we may sustain as a result of the participation of the Minor(s) in the Activities.
Permission to Photograph
Permission to Photograph
I agree to grant ABNC the following.
I hereby grant to ABNC the right to use the name, photograph and recording (video or otherwise) of each Minor, at any time, and from time to time, for the purpose of advertising, publicity, and for promotion of ABNC and the Activities in any manner of media without compensation or advance notice.
Today's Date*
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Camp Children

General Information

Assumption of Risk

Permission to Photograph

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CONTACT US

Child Name (full)	Age	Important Information	Provincial Health Card Number

Full Name	Phone Number	Email Address	Relation

Full Name	Relation	Cell Phone	Other Phone (work, home, etc)