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Day camp Participant waiver
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
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
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Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
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French Guiana
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French Southern Territories
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Gambia
Georgia
Germany
Ghana
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Greenland
Grenada
Guadeloupe
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Guinea-Bissau
Guyana
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Indonesia
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Isle of Man
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Italy
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Japan
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Jordan
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Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
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Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
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South Sudan
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Sudan
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Sweden
Switzerland
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Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
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Turks and Caicos Islands
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Türkiye
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Uganda
Ukraine
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United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Parent/Guardian
First
Last
Relationship to Participant
Phone
Email
Additional Campers
Camper #2
Age
D.O.B
Camper #3
Age
D.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
Phone
Email
Emergency Contact Name #1
First
Last
Emergency Contact Phone #1
Emergency Contact Email #1
Emergency Contact Name #2
First
Last
Emergency Contact Phone #2
Emergency 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 Agree
I 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 Agree
I 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