Emergency Contact and Consent Form - Camp

Camper First Name

Camper Last Name

Emergency Contact(s)

First & Last Name

Phone number

Alternate phone number

Add another contact Remove

Person(s) Permitted to Pick-up Camper

Someone other than the Emergency Contact(s) listed above is permitted to pick-up my child from camp.

Yes

No

I understand that by checking the box below I am agreeing that my child will only be released to the person(s) whom I have identified above as an Emergency Contact or Person Permitted to Pick-up Camper and the person(s) may be required to show proof of identification. I hereby release the City of Oshawa and its staff from any legal liability and from all claims that may arise due to or relating to my child leaving camp with the Emergency Contact or Person Permitted to Pick-up Camper noted herein.

I, the parent/guardian, consent to the above.

Yes

Parent/Guardian First and Last Name

Medical Information

Please indicate if any of following apply to your camper:

Known medical condition(s)

Yes

No

Known allergy (including food )

Yes

No

Required to take medication during the camp day.

Yes

No

Will have an EpiPen with them at camp.

Yes

No

Photograph Consent
I give permission to the Corporation of the City of Oshawa (the “City”), its employees, agents, and assigns to take photographs of my child and/or myself during this course session and use my photograph in the City’s future promotional materials, including on the City’s website. I understand that the City cannot control unauthorized use of my photograph once the photograph has been published. I hereby forever waive any right to inspect or approve any photograph taken by the City.

I, the Parent/Guardian, agree to the above Photograph Consent.

Yes

No

Parent/Guardian First and Last Name

I give permission for City of Oshawa staff to give my child food or drink as part of the camp program

Yes

No

Parent/Guardian First and Last Name

Permission to Walk Home Unaccompanied

Applicable to campers 10 years of age or older.

I understand that by checking the box below I give my consent to allow my child to walk home from camp without an accompanying adult. I understand that I am responsible for my child when camp has concluded, and I hereby release the City of Oshawa and its Staff from any and all legal liability and claims that may arise due to or relating to my child walking home unaccompanied from camp.

Consent for child to walk home from camp.

I, the parent/guardian, consent to the above statement. My child is allowed to walk home unaccompanied by an adult.

I, the parent/guardian, do not give consent for my child to walk home unaccompanied by an adult or, my child is under 10 years of age.

Parent/Guardian First and Last Name

This form may contain personal information as defined under the Municipal Freedom of Information and Protection of Privacy Act. This information is collected under the legal authority of the Municipal Act, 2001, S.O. 2001 c.25, as amended. This information will be used and maintained by the City of Oshawa to provide camp staff with appropriate contact information for campers. Questions regarding this collection may be directed to the City’s Information Access and Privacy Officer at 905-436-3311.

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Emergency Contact and Consent Form - Camp

Emergency Contact(s)

Person(s) Permitted to Pick-up Camper

Medical Information

Permission to Walk Home Unaccompanied