Summer Day Camp Registration Form | St. Matthew's Anglican Church, Islington

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Child #1: First Name / Middle / Last

Name commonly used

Gender

Allergies (please list)

Date of Birth (DD/MM/YYYY)

School graded completed as of June 2024

Friend you would like to be with at camp (first & last name)

Additional children to register? Please scroll down.
Before submitting the form, please ensure you read and check boxes for photography consent and the camp waiver.

Parent/Guardian Information

(Primary Contact) First & Last Name

Address 1

Address 2

City

Zip / Post Code

Phone

(Secondary Contact) First & Last Name

Address same as primary contact

Address (if different)

Phone

Additional Children

Child #2: First Name / Middle / Last

Name commonly used

Gender

Allergies (please list)

Date of Birth (DD/MM/YYYY)

School graded completed as of June 2024

Friend you would like to be with at camp(first & last name)

Child #3: First Name / Middle / Last

Name commonly used

Gender

Allergies (please list)

Date of Birth (DD/MM/YYYY)

School graded completed as of June 2024

Friend you would like to be with at camp (first & last name)

Child #4: First Name / Middle / Last

Name commonly used

Gender

Allergies (please list)

Date of Birth (DD/MM/YYYY)

School graded completed as of June 2024

Friend you would like to be with at camp (first & last name)

Photography Consent

By checking this box I GIVE CONSENT to the use of images of myself and my children in publications that support the church, either online, for presentations, or in print. I understand that no financial remuneration is associated with such publication of my photograph or that of my children now or in the future. I understand that this permission may be withdrawn at any time by contacting the church office by telephone, email, or in writing.have the images used as indicated above, for myself (and my children).

I DO NOT wish to have the images used as indicated above.

Please review the waiver below and sign by typing your name.

I hereby give my permission for my child to participate in the St. Matthew’s Anglican Church Camp Matt Program. I understand that camp activities could include play and outdoor activities around and near the church grounds. I agree to see that my child is appropriately attired for camp activities. In the event of illness, injury, and/or accident, I authorize the camp staff/volunteer to act on my behalf. They may approve any, and all non-emergency or emergency treatment and are authorized to sign any, and all medical release or required form(s) on my behalf. In the event of an emergency, I understand that I will be notified of the situation as soon as possible given the circumstances. I understand that St. Matthew’s Anglican Church Islington may, in its sole discretion, dismiss any camp participant for inappropriate, disrespectful, or dangerous behavior at any time. In this event, I understand that I will not receive a refund of camp fees for unattended days. If my child breaks or damages any property as a result of their direct or indirect behavior, I hereby agree to pay for its repair or replacement. I understand that the risks associated with camp activities, although unlikely, could result in injury and in extremely unlikely circumstances, death to my child. I hereby assume these risks and, knowing them, hereby give my child permission to participate. I understand that the St. Matthew’s Anglican Church Islington is not liable for any injuries or other occurrences due to indoor and outdoor camp activities or related risks, and/or the actions or omissions of St. Matthew’s Anglican Church Islington counselors, volunteers, employees, wardens, or any other entities being released. In consideration of my application and permitting my child to participate in this activity, I hereby: WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of St. Matthew’s Anglican Church Islington, its wardens, employees, volunteers, entities or other persons released, for my child’s death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to them including their traveling to and from this activity; INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE St. Matthew’s Anglican Church Islington, its wardens, employees, volunteers, or other entities or persons released from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise purpose by the activity holders, producers, sponsors, organizers, and assigns. The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

By checking this box I certify that I have read, fully understand, and agree to the terms of St. Matthew's Camp Matt Accident Waiver and Release of Liability form.