Step 1 of 5 20% Name and Date of Camp(Required) Name of Camper(Required) Age(Required)D.O.B(Required) Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Parent/Guardian First Last Relationship to Participant PhoneEmail Additional CampersCamper #2 AgeD.O.B Camper #3 AgeD.O.B If someone other than the previous mentioned parent/guardian will be dropping off or picking up, please fill out the box below Name First Last PhoneEmail Emergency Contact Name #1 First Last Emergency Contact Phone #1Emergency Contact Email #1 Emergency Contact Name #2 First Last Emergency Contact Phone #2Emergency Contact Email #2 Please list any allergies, medical concerns, medication(s) or dietary restrictions below.Please list anything we should know to make your child’s camp experience better, including fears, behaviours, or other special needs. River of Death Dino Day Camp Waiver of Claims, Release from Liability and Behavioral Care Plan Please read this document carefully before signing. By signing in the space provided at the bottom of this waiver, you are confirming that your dependent(s) of which you will sign on his or her behalf, wish to participate in the day camp and agree to the terms and conditions outlined below.I acknowledge and agree that in exchange for Consent(Required) I AgreeI acknowledge and agree that in exchange for and as a condition of my participation, and/or the participation of my child (ren) that I assume full responsibility for any damage to property which may be sustained in connection with me or the participation of my child (ren), named above, in any of the activities below. Parent Name for Consent(Required) First Last Child Name for Consent(Required) First Last I acknowledge on behalf of myself and my child the following expectations at our Summer Camps: My child(ren) will behave in a responsible manner and will remain with group and staff at all times and not leave without first asking staff. This is a safety rule. My child(ren) will be respectful to others and their property, including that of the Philip J. Currie Dinosaur Museum and Pipestone Creek Park, and not use anything without permission. My child(ren) will not take any food out of the designated eating space(s) without first asking staff. Parents/Guardians have disclosed to Museum staff/Camp leaders any allergy, medical or learning conditions that may affect my child(ren)’s ability to safely participate in this activity. My child will respect Camp Counsellors and not use inappropriate language or disrespectful behaviour towards them or others in the camp. We do not tolerate violent behavior. We ask that your child does not trade or share snacks with other children as this may pose a medical issue to those with allergies. Parents are asked to provide a lunch, snacks and water for their child(ren). All lunches/snacks must be NUT FREE and not need refrigeration. All children MUST be completely toilet trained to attend the summer camps and be able to use the toilets on their own. Parents are asked to provide spare clothing and appropriate outerwear for an “outdoor summer camp experience.” Please ensure these items can get dirty. Please note, We will be tie dying camp shirts Please ensure that children are picked up and dropped off on time. The bus leaves the museum to Pipestone Park at 9:15am and returns to the Museum by 3:10pm. Children must be picked up on time, unless late pick up or early drop of was purchased. Camps run 9-4pm. If parents miss the bus, they are responsible to bring their child to Pipestone Creek Park for the summer camps. Behavioural Plan I understand that there will be consequences if myself or my child’s behaviour at any time during this event violates the camp expectations listed above or in any other way interferes with the safety and well-being of camp staff, other children at camp or themselves. The process of dealing with disruptive or unsafe behaviour is as follows- Child will be reminded of the Camp Rules A written note of the incident will be drafted and given to parents at pick up. Staff will provide parents with the opportunity to discuss the incident. If behaviors occurs again, a formal meeting with the Programs Manager and Camp Leader will follow before the child is able to continue participating in the summer camp. If the child’s behaviour is deemed a safety concern and the above steps have been followed, the child may be removed from the summer camp. ALBERTA Freedom of Information and Protection of Privacy Act (FOIPP): By signing below, I consent to having the information in this document collected by the Philip J. Currie Dinosaur Museum under the operation of the River of Death & Discovery Dinosaur Museum Society and the County of Grande Prairie No. 1. The personal information requested on this form is collected under the authority of the Universities Act and Section 32 (c) of the FOIPP Act. Certain Personal information may be made available to federal and provincial government departments and agencies under appropriate legislative authority. Personal information is protected under the Alberta FOIPP Act. ACKNOWLEDGEMENT I have read and understood this agreement and I am aware that by signing this agreement, I am waiving certain legal rights, which I or my heirs, next of kin, executors, and administrators may have against the Philip J. Currie Dinosaur Museum under the operation of the River of Death & Discovery Dinosaur Museum Society and the County of Grande Prairie No. 1. Guardians Name:(Required) Guardians Signature(Required)Dependents Name:(Required) Date Signed:(Required) MM slash DD slash YYYY WAIVER AND RELEASE OF LIABILITY In consideration of being allowed to participate in any way in the day camp at the Philip J. Currie Dinosaur Museum and Pipestone Creek Park on the ______ day of ___________, 20____, along with related events and activities, the undersigned acknowledges, appreciates, and agrees that: I recognize and understand that my participation in the River of Death Dino Camps involves certain risk, including but not limited to, risk of injury during physical games, possible injury sustained from craft-making and other related activities, and possible injury and discomfort sustained from being outdoors. This risk will be minimized to the best of the ability by museum staff, however, associated risks with camp are still present. I knowingly and freely assume all such risks and assume full responsibility for any and all damages they may arise out of my child’s participation. I willingly agree to comply with the stated and customary terms and conditions for participation. If however I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately. I, for myself and on behalf of my executors, administrators, personal representatives, heirs, successors, and assigns, hereby release and hold harmless the River of Death & Discovery Dinosaur Museum Society, the Philip J. Currie Dinosaur Museum, and The County of Grande Prairie No. 1 (‘The Releasees’) any and all loss, theft, property damage, or bodily injury sustained to myself or my child during my child’s participation in this camp. Date Participation(Required) MM slash DD slash YYYY I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.PARTICIPANT/GUARDIAN SIGNATURE(Required)DATE SIGNED(Required) MM slash DD slash YYYY FOR PARTICIPANTS OF MINORITY (UNDER AGE 18 AT TIME OF REGISTRATION) This is to certify that I, as a parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above. PARENT/GUARDIAN SIGNATURE(Required)EMERGENCY PHONE NUMBER(Required) PHOTO RELEASE FORM Consent I AgreeI hereby authorize and give full permission to the Philip J. Currie Dinosaur Museum, the County of Grande Prairie No .1, and the River of Death & Discovery Dinosaur Museum Society, including is volunteers, employees, directors, officers, agents, successors and assigns, to photograph my child to otherwise fix his/her image in any manner and in any medium including, but not limited to films, slides, videotape, pictures, brochures, banners, magazines, data storage; and/or to the use of his or her voice recorded or fixed form in any manner including, but not limited to, publicity purposes or promotional material, or other manner or medium deemed appropriate.Parent Name for Consent(Required) First Last Child Name for Consent First Last Please fill out the information and sign below to acknowledge that you have read and understood the above statements,Parent/Guardian Name (Printed)(Required) Parent/Guardian Signature(Required)Date (mm/dd/yy):(Required) MM slash DD slash YYYY
