Destination North Discovery Group Summer Discovery Camp

Registration, Waiver, Consent, and Medical Data

Name of Participant

Date of Birth

Address

Health Card Number

City

Province and Postal Code

Name of Parent/Guardian (1)

Name of Parent/Guardian (2)

Daytime Phone (e.g. mobile or work)

Daytime Phone (e.g. mobile or work)

Evening Phone

Evening Phone

Email

Email

Relationship to Camper

Relationship to Camper

MEDICAL QUESTIONNAIRE
Does the participant have any physical,
mental/developmental, or medical conditions that for
safety reasons should be disclosed?
Has the participant ever had an injury or accident
requiring ongoing medical attention or surgery?
Does the participant have allergies or asthma?

YES
YES
YES

If YES please add to

Camper Profile
If YES please add to
Camper Profile
If YES please complete
the Medical Consent

NO
NO
NO

PICK-UP AND DROP-OFF

Participants must be signed in and out each day at drop-off and pick-up. In addition to the registering parent/guardian,
only the following people are permitted to sign the participant out. Please provide the names and information below. All
persons listed must show photo ID and that ID must match the name on this list. Please print clearly.
Full Name

Relationship to Camper

Full Name

Relationship to Camper

Full Name

Relationship to Camper

Full Name

Relationship to Camper

RECENT PHOTO OF CHILD

PHOTO AND MEDIA WAIVER

Request for permission to take, use, copy, or display participants photograph or video recorded image to promote
Destination North Discovery Group and Partner events and advertisements on websites, social media, news releases,
brochures, pamphlets or other:
Yes, I grant permission to DNDG and Partners to take and use my childs photo or video recorded image for
promotional purposes. These images will only be used for DNDG and Partners use and will not be sold, traded,
or given to any other organization or group.
No, please do not take or use my childs photo or video recorded image. I understand that it is my
responsibility to explain to my child that they may not take part in photos or video recordings.

PAYMENT INFORMATION
I understand that my childs spot is not guaranteed until I have paid in full the balance of their fees. The total cost given
includes all provincial and federal taxes, as well as all Camp transportation and activities, and a Camp hat. Fees must be
paid in full at least two weeks before the Camp begins to avoid late charges.
The cost is $190 per child. If a household has two or more children the cost is $180 per child. Proof of address may be
required. Payment is accept by cash, cheque (made out to Destination North Discovery Group), or online at
www.millmarket.ca/discovery-Camp. A late fee of $25 per child will be assessed if registration and payment are not
received on time.
Please indicate which week(s) registered for by circling the appropriate one(s):
* Week 1 July 6 to 10 Pollinator Pals

* Week 2July 13 to 17 Tale Spinning

* Week 3July 20 to 24 Exploration & Adventure

* Week 4July 27 to 31 Paper Trails

* Week 5August 10 to 14 Biology Blitz

* Week 6August 17 to 21 Edible Exploration

* Week 7August 24 to 28 Animal Detectives

Total No. of Weeks Selected ________ x $190 = ______________ Total Payment Due
Payment Type Received
Cash __________

Cheque __________ Online ___________ Receipt/Confirmation # __________________________

IMPORTANT! PARENT/GUARDIAN CONSENT OF PARTICIPATION AND WAIVER

Destination North Discovery Group, its Staff, its partners, and its partners Staff referred to as the Camp
Participant named on this information referred to as the Camper
35 Canal Drive, Sault Ste. Marie ON referred to as the Camp Property
By submitting and signing this form, I acknowledge that I am aware that there are risks associated with the various
activities undertaken by the Camp and Campers. I warrant that the participant named on this information form is
physically fit to participate in all reasonable and average activities for their age. I declare that I have accurately
disclosed all information regarding physical, mental, or medical conditions affecting the named participant and
acknowledge that this information may be used by the Camp Staff in the delivery of this program. I understand
that the Camp has tried to create a safe and controlled environment for participation and that the Camp has
established rules for participation that must be followed by the participant. I understand that failure to comply
with any of the policies and rules of the Camp may result in the suspension or termination of the Camper in the
Camp. I waive the rights of the participant to damages or other costs in the event injury is caused due to
participation in any event or other involvement with the Camp. I hereby give permission for emergency medical
treatment to be administered to my son/daughter, as may be determined in the reasonable discretion of the
Camp Staff. It is understood that whenever reasonably possible, relatives will be contacted and informed of the
problem, diagnosis, treatment required and anticipated medical results. I agree to allow my son/daughter to
participate in all Camp activities and in any supervised trips to places not on the Camp Property.

I UNDERSTAND THAT IT IS MY RESPONSIBILITY TO ENSURE THAT THE INFORMATION ON THIS FORM IS KEPT CURRENT
AND I WILL NOTIFY THE CAMP OF ANY CHANGES IMMEDIATELY.
Upon registration of my child at the Destination North Discovery Group Summer Discovery Camp I permit my child to
participate in a wide range of activities, including yoga, outdoor activities, off-site field trips, and more.
Name of Participant
Name of Parent/Guardian (1)

Name of Parent/Guardian (2)

Signature of Parent/Guardian (1)

Signature of Parent/Guardian (2)

Date

Date

*** Please receive and retain your receipt from us as proof of payment ***