Grades 3-6 March Break Trip

When: March 10th-12th, 2018

Cost: $130 per child until December 24th, 2017 after $150 until February 11th, 2018

We’ll have lots of fun. Get your bag ready from now! 
Don’t miss the chance, as spots are very limited.

* LAST day to register and pay ONLINE *

 * Sunday, February 11th, 2018 *

Participant Name:*
Date of Birth:*
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 / 
Select Grade:*
Rooming members:
OHIP Health Card:*
Allergy:
Medical History:
Parental/Guardian Name:*
E-mail:*
Home Phone:
-
Cell Phone:*
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Emergency Contact:*
Cell Phone:(1)*
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Home Phone:(1)
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I am also aware that there are additional risks in travelling to and from locations where activities are taking place.

It is our policy to notify a parent when a child is ill or needs medical attention. Occasionally we cannot contact parents and we need to get immediate help for the child. I acknowledge this and by signing the form I confirm that the servants can take appropriate action on behalf of my child. We will take this signed consent to the emergency centre.

I acknowledge that program staff may limit my child’s access to the program or facilities in the event of any misuse of the facilities or misconduct on my child’s part.


This information is confidential. It enables the instructors and guides to reduce the risk of injury or illness complications, as well as to prepare emergency plans in the event that an emergency does occur.

I have honestly disclosed all of the information requested in the questions; and I understand that withholding information may contribute to injury or illness complications, and possibly compromise the care provided in the event of an emergency. If any of the above information changes prior to, or during the program, I will immediately notify the leader.

Consent:*

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