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Organisation:
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Événement:
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Science ALIVE Summer Camps 2024 - Burnaby
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Date et heure:
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Mar, 02-Jul-2024 - Ven, 23-Aou-2024
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| Personne 1: |
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| Prénom: | (*) |
| Nom: | (*) |
| Adresse: | (*) |
| Apt.: | |
| Ville: | (*) |
| Code postal: | (*) |
| Prov./Etat: |
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| Pays: |
(*) |
| Téléphone (maison): | (*) |
| Téléphone bureau: | |
| Téléphone (cell): | |
| Courriel: | (*) |
| | J'ai lu et je suis d'accord avec le Contrat d'Utilisateur (*) |
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| PARTICIPANT INFORMATION |
| Prénom: | (*) |
| Nom : | (*) |
| Preferred Name (if other than name listed above): |
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| Date de naissance: |
(*) Why do we ask this? The Children's Online Privacy Protection Act (COPPA) requires that companies not store any personal information for users younger than 13 without parental consent |
| Student's Care Card Nr: | Why do we ask this? Care card and insurance information provided for each participant is only accessed for the purpose of medical emergency, and will be erased from our system when Science AL!VE Summer Academy Camps are complete. If you have travel insurance, please bring/fax/scan a copy of the insurance to us |
Please select the grade first. Only camps for your child's grade will be shown.
*Participants must have finished Kindergarten to be enrolled in Science Academy camps. |
| Grade the participant is attending in the coming school year (2024-2025) |
| Grade (2024-2025): |
(*) |
| Ecole: | (*) |
| Has the participant attended Science AL!VE Camps before? |
| Previous SA Camps: | (*) |
| How did you hear about Science AL!VE camps? |
(*) |
| Heard about / Other: | |
| T shirt size (in youth): |
(*) |
| What is the participant's primary language(s) spoken at home? |
| Primary Language: | (*) Why do we ask this? Participants are suggested to have a conversational level of English comprehension. The inability to converse with the camp staff can lead to potential removal from our programs |
| Genre: | (*) |
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| HEALTH AND BEHAVIOUR |
| Does your child have dietary restrictions or allergies? |
(*) |
| If your child has dietary restrictions or allergies, what are they? | |
| Does the participant have an epipen? |
(*) |
| If yes, where would the epi pen be stored? | |
| Does the participant have any behavioural concerns or exceptionalities? E.g. ADHD, Autism, Anxiety, etc |
(*) |
| What is your child's behavioural concern or exceptionality? | |
| Please include any information regarding how your child expresses their exceptionality and any directions to help redirect to alleviate their behaviours if relevant. |
| Strategies and tools used at school/home: | |
| Is there anything else you think we should know? | |
| Does the participant require any medication or treatment during the program? Please include necessary details about medication, administration methods, frequency, etc |
| Medical details: | |
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| CAMP SIGNOUT |
Sign Out Consent - How would you like the participant to be signed out?
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| Self Sign Out: The camper signs themselves out of the day, not guardian signature required.
Guardian Sign Out: The camper must be picked up and signed out by an authorized person on the guardian release list
*PLEASE NOTE: Only children 12 years or older are allowed to self-sign out |
| Sign Out Consent: |
(*) |
| Guardian Release *Provide full names as listed on Government Issued ID |
| Auth. Person 1 First Name: | |
| Auth. Person 1 Last Name: | |
| Auth Person 2 First Name: | |
| Auth. Person 2 Last Name: | |
| Auth. Person 3 First Name: | |
| Auth. Person 3 Last Name: | |
| Auth. Person 4 First Name: | |
| Auth. Person 4 Last Name: | |
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| CAMPS |
| Week 1: July 2-5 (4 days) |
| W1-MS: |
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| W1-QS: | |
| W1-JS: | |
| W1-SS: | |
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| Week 2: July 8-12 |
| W2-MS: | |
| W2-QS: | Waitlist: |
| W2-JS: | |
| W2-SS: | |
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| Week 3: July 15-20 |
| W3-MS: | |
| W3-QS: | Waitlist: |
| W3-JS: | |
| W3-SS: | |
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| Week 4: July 22-26 |
| W4-MS: | |
| W4-QS: | Waitlist: |
| W4-JS: | |
| W4-SS: | |
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| Week 5: July 29 - August 2 |
| W5-MS: | |
| W5-QS: | Waitlist: |
| W5-JS: | |
| W5-SS: | |
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| Week 6: August 6-9 (4 days) |
| W6-MS: | |
| W6-QS: | Waitlist: |
| W6-JS: | |
| W6-SS: | |
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| Week 7: August 14-18 |
| W7-MS: | |
| W7-QS: | Waitlist: |
| W7-JS: | |
| W7-SS: | |
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| Week 8: August 21-25 |
| W8-MS: | |
| W8-QS: | Waitlist: |
| W8-JS: | Waitlist: |
| W8-SS: | |
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Before and After Care:
Only those weeks corresponding to your camp selection above will show.
Before Care: Science AL!VE offers supervision for campers who need to be dropped off before camp, before cares runs from 7:45 AM - 8:50 AM
After Care: ScienceAL!VE offers supervision for campers who need to be picked up after camps has ended, after care runs from 3:30 PM - 5:00 PM |
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| WAIVERS AND AGREEMENTS |
Waivers
Community guidelines
By registering for this camp, you are acknowledging and agreeing that the FAS Outreach Program reserves the right to refuse further attendance by any participant for infractions of community guidelines without refund of camp fee.
Photography consent
During registration, you will be asked to provide consent for photography. You have the option to select No if you prefer your child not to be photographed. If you select Yes, you will be agreeing to the following terms:
Photography of participants
We would like to seek your permission to photograph your child during the event, to help with future promotions of our programs. By giving us our consent, you authorize the Faculty of Applied Sciences (FAS) Outreach program of Simon Fraser University to photograph, audio record, video record, podcast and/or webcast your child (digitally or otherwise) without charge; and to allow the FAS Outreach Program to copy, modify and distribute in print and online, those images that include your child in whatever appropriate way either the FAS Outreach Program and/or SFU sees fit without having to seek further approval. No names will be used in association with any images or recordings. |
| Indemnity Agreement: | I agree to INDEMNIFY, PROTECT, DEFEND, AND HOLD HARMLESS the FAS Outreach Program (with Science AL!VE) and SFU, and its governors, directors, officers, employees, and agents from and all costs, suits, claims, losses, and expenses, including all reasonable legal fees and other costs of litigation, resulting directly or indirectly from my [or my child’s] participation in the program, including but not limited to any damage to my property or personal injury to me [or my child], and for personal injury or property damage suffered by any third party resulting from my [or my child’s] actions whilst participating in the program, except to the extent that the same may be attributable to the negligence of the indemnified parties. |
| Removal for Rule Breaking: | I acknowledge and agree that the FAS Outreach Program (with Science AL!VE) reserves the right to, and may, refuse further by any participant for infractions of community guidelines. A community guidelines document will be provided closer to the first day of camp. |
| Photo Waiver: | We would like to seek your permission to photograph your child during the event, to help with future promotions of our programs. By giving us our consent, you authorize the Faculty of Applied Sciences (FAS) Outreach program (with Science AL!VE) of Simon Fraser University to photograph, audio record, video record, podcast and/or webcast your child (digitally or otherwise) without charge; and to allow the FAS Outreach Program to copy, modify and distribute in print and online, those images that include your child in whatever appropriate way either the FAS Outreach Program and/or SFU sees fit without having to seek further approval. No names will be used in association with any images or recordings. |
| I accept the photo waiver | (*) |
| Permission to share your child’s work: | We would like to seek your permission to share images and videos of your child’s work on our website, social media channels, and other digital outputs (such as e-newsletter) for the purpose of education and promotion. By giving us your consent, you also acknowledge and accept the risk that the Internet is not a secure medium; that any material posted on the Internet is accessible to anyone with Internet access. |
| Permission to share your child’s work: | (*) |
| Medical Services Waiver: | I agree to allow SFU staff to provide or cause to be provided to me or my child such medical services as SFU or medical personnel consider appropriate. |
| Politique sur le remboursement: | The Faculty of Applied Sciences (FAS) Outreach Unit (with Science AL!VE) is able to offer refunds under the following circumstances:
- If you cancel your camp registration more than 7 days before the camp’s start date, you will receive a refund of the program fee minus a $35 cancellation fee.
- If you cancel your camp registration 7 days or less before the program’s start date, no refund will be issued.
- A $10 transfer fee will be imposed if requesting a change to a different camp week.
- A refund upon receiving a written medical recommendation from a doctor will be issued. This amount will be calculated based on the number of days the participant attended the program.
- A refund may be considered upon receiving a written recommendation from program coordinator/manager outlining why the program is not suitable for the participant. This amount will be calculated based on the number of days the participant attended the program minus a $35 administration fee.
- If any camps are cancelled by FAS Outreach, a full refund will be issued |
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PARENT/GUARDIAN INFORMATION
Primary Parent / Guardian |
| Prénom: | (*) |
| Nom: | (*) |
| Relationship to Participant: |
(*) |
| Relationship other: | |
| Phone number: | (*) Format: ###-###-#### |
| Second Parent / Guardian: |
| Prénom: | |
| Nom: | |
| Relationship to participant: |
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| Relationship other: | |
| Phone number: | Format: ###-###-#### |
| Contact en cas d'urgence: |
(*) |
| If possible, provide a contact that is different than the primary contact in the event we cannot reach you. |
| Prénom: | |
| Nom: | |
| Relationship to participant: | |
| Phone number: | (*) Format: ###-###-#### |
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| Code de promotion: | |
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| Signature: |
(*) |
| By signing below, I confirm that all information is correct and that I have read and agree to all of the waivers that I have selected above. |
| Signature: | (type your full name) |
| Signature: |
Please sign here using your mouse (click and hold the mouse button on PC or Mac) or your finger (on tablet or phone)
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| | (*) information requise |
| | Sauvegarder mon information pour mes prochaines inscriptions |
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| Utilisez cette section pour envoyer un message à l'organisateur ou pour un rappel pour vous-même. |
Commentaire: |
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