YMCA of Regina Summer Day Camps Youth InformationCamper's Name* First Last Camper's Gender* Male Female Other Camper's date of birth* Month Day Year Camper's Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Transportation arrangements:* Parent/Guardian InformationMain Contact: Parent/Guardian Name* First Last Parent/Guardian date of birth* Month Day Year Is the parent/guardian address the same as the Camper's listed above?* Yes No Address - *if different than Camper's address listed above* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Parent/Guardian Phone*Parent/Guardian Email* Emergency Contact/Authorized Pick-upEmergency Contact/Authorized Pick up* First Last Phone*Relationship to Camper* Emergency Contact/Authorized Pick-up First Last PhoneRelationship to Camper Camper's Medical InformationSaskatchewan Health Card Number*Does the Camper have any known allergies?* Yes No Allergies* Does your child carry medication for their allergies?* Yes (If yes, parents/guardians must complete a medication release form on campers first day ) No Describe any physical/medical conditions that may restrict your child's participation in camp activities. How can staff best assist your child during camp activities?*Please enter N/A if not applicableCamp SchedulePlease select the week(s) of camp the Child above is being registered for* Week 1 | July 2-5 | Artful Antics Week 2 | July 8-12 | Swim Camp Week 3 | July 15-19 | Monsters & Misfits Week 4 | July 22-26 | Swim Camp Week 5 | July 29-August 2 | Swim Camp Week 6 | August 6-9 | Incredible Engineers Week 7 | August 12-16 | Swim Camp Week 8 | August 19-23 | The Great YMCA Games Week 9 | August 26-30 | Camp Rewind Select all that apply (limited spaces are available)What is the Campers current swim level?* General Liability & Photo ReleaseRelease of Liability and Assumption of Risk Waiver* I understand that the YMCA of Regina assumes no responsibility for injuries or illnesses which I, my spouse/partner, or my minor children or any other person may sustain as a result of my/their physical condition, this program, my/their use of any facility or my/their participation in any activities, programs, exercise, or use of any equipment (collectively, "Activities"). I expressly acknowledge on behalf of myself, my spouse/partner, my minor children and our heirs that I assume the risk for any and all injuries, illnesses, death, loss or damage which may result from any of the foregoing. I herby release and discharge the YMCA of Regina, its agents, servants, and employees from ay and all claims for injury, illness, death, loss or damage which I, my spouse/partner, or minor children may suffer as a result of their physical condition, this program, the use of any facility, or participation in any Activities. Participants are prohibited from possessing or using alcohol, tobacco products, non-prescription drugs, and weapons of any kind. Participants must follow safety instructions of YMCA staff, and refrain from harmful behavior. Failure to comply with thes YMCA policies will result in immediate dismissal from YMCA programs without refund.*Consent I give my permission to the YMCA of Regina to use indefinitely, without limitation or obligation, photographs, film, footage, or tape recordings which may include my, my spouse/partner's or minor children's image or voice for purposes of promoting or interpreting YMCA Programs. YMCA of Regina Summer Day Camps Youth InformationCamper's Name* First Last Camper's Gender* Male Female Other Camper's date of birth* Month Day Year Camper's Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Transportation arrangements:* Parent/Guardian InformationMain Contact: Parent/Guardian Name* First Last Parent/Guardian date of birth* Month Day Year Is the parent/guardian address the same as the Camper's listed above?* Yes No Address – *if different than Camper's address listed above* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Parent/Guardian Phone*Parent/Guardian Email* Emergency Contact/Authorized Pick-upEmergency Contact/Authorized Pick up* First Last Phone*Relationship to Camper* Emergency Contact/Authorized Pick-up First Last PhoneRelationship to Camper Camper's Medical InformationSaskatchewan Health Card Number*Does the Camper have any known allergies?* Yes No Allergies* Does your child carry medication for their allergies?* Yes (If yes, parents/guardians must complete a medication release form on campers first day ) No Describe any physical/medical conditions that may restrict your child's participation in camp activities. How can staff best assist your child during camp activities?*Please enter N/A if not applicableCamp SchedulePlease select the week(s) of camp the Child above is being registered for* Week 1 | July 2-5 | Artful Antics Week 2 | July 8-12 | Swim Camp Week 3 | July 15-19 | Monsters & Misfits Week 4 | July 22-26 | Swim Camp Week 5 | July 29-August 2 | Swim Camp Week 6 | August 6-9 | Incredible Engineers Week 7 | August 12-16 | Swim Camp Week 8 | August 19-23 | The Great YMCA Games Week 9 | August 26-30 | Camp Rewind Select all that apply (limited spaces are available)What is the Campers current swim level?* General Liability & Photo ReleaseRelease of Liability and Assumption of Risk Waiver* I understand that the YMCA of Regina assumes no responsibility for injuries or illnesses which I, my spouse/partner, or my minor children or any other person may sustain as a result of my/their physical condition, this program, my/their use of any facility or my/their participation in any activities, programs, exercise, or use of any equipment (collectively, “Activities”). I expressly acknowledge on behalf of myself, my spouse/partner, my minor children and our heirs that I assume the risk for any and all injuries, illnesses, death, loss or damage which may result from any of the foregoing. I herby release and discharge the YMCA of Regina, its agents, servants, and employees from ay and all claims for injury, illness, death, loss or damage which I, my spouse/partner, or minor children may suffer as a result of their physical condition, this program, the use of any facility, or participation in any Activities. Participants are prohibited from possessing or using alcohol, tobacco products, non-prescription drugs, and weapons of any kind. Participants must follow safety instructions of YMCA staff, and refrain from harmful behavior. Failure to comply with thes YMCA policies will result in immediate dismissal from YMCA programs without refund.*Consent I give my permission to the YMCA of Regina to use indefinitely, without limitation or obligation, photographs, film, footage, or tape recordings which may include my, my spouse/partner’s or minor children’s image or voice for purposes of promoting or interpreting YMCA Programs.