Personal Information Form 2018 (12-14)

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Kids 'n Nature Summer Day Camp

Personal Information Form (12 to 14)

This form must be submitted upon camp registration.  Updates can be submitted later by email.  Campers cannot attend camp without a current personal information form on file PRIOR to camp.

The information on this form may be used by and shared with The Friends of Presqu’ile representatives or medical personnel to support the health and safety of your child/ward and to obtain your permission on who may pick up your child.

You child’s/ward’s health information is reviewed only by staff.  It is shared with other adults on a ‘need to know’ basis in our effort to support his/her participation.  If your child/ward has any disabilities that may require accommodation, disclosing and discussing them with us will help us accommodate him/her.  Use this form to explain your child’s needs.

Parent/Guardian Information:

All information about camp will be sent to this email address and any phone calls will go to the number listed below:


Camper Information
Year of Birth (Child must be 12 to 14 in this calendar year)
Has the child attended Kids n Nature camp before? *If camper has not attended our camp before, confirmation of birth date (copy of birth certificate or health card) must be emailed to before registration will be confirmed
Return Camper*

Other Person(s) authorized to pick up your child and contact for Medical Emergency Information
We strive to provide the safest possible environment for your child. In keeping with that goal, staff will release your child/ward to individuals who have been authorized by you to pick up your child/ward after camp. In the space below, please list up to four people who may pick up your child. List individuals below in addition to parent/ guardian.
Contact #1
Contact #2
Contact #3
Contact #4

Camper Health Information
Camp activities may include swimming, running, hiking, pitching tents, playing games, riding a bus.
1. Does the camper have any physical or cognitive limitations/challenges that would require assistance and/or modifications to the program to enable him/her to participate fully? If yes, please give particulars. Leave blank if not applicable
2. Does the camper have any behavioural or emotional challenges that would affect their interactions with staff and fellow campers? If yes, please give details. If no, leave blank.
3. Do you have any special instructions for staff regarding the camper’s health care and/or diet? If yes, please give particulars. If no, leave blank.
4. If the camper has allergic reactions to such things as food, insect stings, etc., please list the type of allergy, describe the details and if it is a life-threatening allergy. If no, leave blank.
5. Does the camper have any chronic condition or recent illnesses of which the staff should be aware If yes, please provide details of treatment required and name of medications he/she will be bringing with him/her if required for the condition. If no, leave blank.
6. Are there any medications that your child should carry his/herself? (e.g. Ventolin inhaler, Epi pen) If yes, please explain. If no, leave blank.
Medications: any medication required by the camper must be brought with him/her in the original packaging with dosage instructions and clearly labelled with name. Medications are given to staff upon arrival at the camp for storage. The staff will supervise the taking of medication by the camper according to instructions provided. The camper must be willing to take their medication. They will not be given any medication that is not provided by parents/guardians.

Photography/Media Consent
Do you give permission for your child to have his/her picture taken during the program? (Photos of camp experience are shared with campers via email after camp.)
Do you give permission for your child to have his/her picture used in future Friends of Presqu ile Park brochures, newsletters etc?

Terms and Conditions
1. All campers must ride the bus to and from camp. Bus pick up is at 8:30a.m. at King Edward Park, Brighton and drop off is at 4:30p.m. at King Edward Park, Brighton.
2. Refund Policy: No fees will be refunded and there will be a $20 charge for N.S.F. cheques.
3. I understand that the staff will be dealing with a variety of children in various settings and that there may be some disciplinary action taken if necessary. I understand that The Friends of Presqu ile Park has a violence - free policy to en sure the safety of all participants. I understand that any behavioural misconduct at the discretion of the staff may result in immediate removal from the program with no money refunded.
4. I agree that The Friends of Presqu ile Park will not be responsible or held accountable for any claims: costs, expenses, actions, and damages with respect to damage and/or bodily injury that may be sustained to my child as a result of participation in Kids n Nature Summer Camp activities.
Having read and understood the above items and conditions in its entirety, I hereby agree to be bound by the terms and conditions, and give my consent for my child to be registered in the Kids n Nature Summer Camp program. *

Please note: Information you provide on this form is collected by The Friends of Presqu ile Park in accordance with the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA), and will not be used for any purpose other than for the operation of the Kids n Nature Summer Camp.
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