Victoria Alliance Day Camp 2018

Day Camp, Monday - Friday, 9am - noon, July 9 - 13th. Day Camp Sunday is July 15th, 10am!

Victoria Alliance Church 1792 Townley Street Victoria, BC

www.victoriaalliance.ca 250 592 1821

Camper Information

Child's First Name (as they like to be called) *

Last Name *

Gender

Birth Date (YYYY-MM-DD) * +

Grade in September 2018

Home Church (if any)

Camper Buddy Request (optional)

Pre-ordered T-Shirt Size - must be registered by June 25th, 2018 We do our best to provide each camper a t-shirt, but registrations received after June 25th may not include a t-shirt. *

Health Card Number *

Physician Name and Phone number

Does your child have any physical, emotional, mental, behavioural concerns or limitations that our staff should be aware of? *

Yes

No

If yes, please explain.

Any FOOD allergies? Please list any food allergens, and the severity of your child's allergy (does "may contain" work, etc).

Other Non-food Allergies, if any?

Is there any other information you think we should have about your child?

Household / Adult Primary Contact

Relationship to Participant: *

Mother

Father

Guardian

Other Other

First Name *

Last Name *

Address 1 *

Address 2

City *

Province *

Postal Code *

Phone (primary) *

Phone (secondary)

Email Address *

We require an alternate adult emergency contact person. Name (first and last): *

Emergency Alternate Phone *

Medical and Care Consent

The safety of your child is our primary concern. Precautions will be taken for their well-being and protection. I/We, the parent(s)/guardian(s) of the above noted child, authorize Pastor Rob Olsen or one of the Victoria Alliance Church Ministry Staff to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above. I/We, named below, undertake and agree to indemnify and hold blameless Pastor Rob Olsen, the Ministry Staff, Victoria Alliance Church, its Pastors and Board of Elders from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of the Day Camp at Victoria Alliance Church, as well as any medical treatment authorized by the supervising individuals representing the church. This consent and authorization is effective only when participating in or traveling to events of the Victoria Alliance Church. *

I/we consent and agree to the above

I/we do not consent or agree with the above

Photo Consent

Please indicate below to grant permission for the reasonable use of pictures containing your child in any or all of the following ways: brochures, posters, in service video, church website, newsletters. Please note: names will not be used with any of the pictures. *

I/we consent to the above

I/we do not consent to the above

Suggested Donation & Other Info

We desire all who want to be at daycamp to be here, regardless of their financial situation. We do have costs associated with providing a quality event for children. To offset these costs, we ask you to consider making a suggested donation to cover costs of our daycamp:

1 camper - $40

2+ campers from the same immediate family - $80

Please note, registrations that are completed by June 25th will include a pre-ordered T-Shirt. After June 25th, we cannot guarantee that we will have a T-shirt for your child.

Please choose a method for donation:

1) mail in cheque, payable to Victoria Alliance Church, 1792 Townley Street, Victoria, BC, V8R 3A7

2) present cheque or cash upon arrival on the first day of camp, or

3) send payment via an e-transfer (interac). Please set up a transfer to the email address: finance@victoriaalliance.ca We suggest that your security answer be DAYCAMP2018

Thank you. Your support is appreciated.

Please select your preferred method for donation.

mail in cheque

bring cheque or cash on first day of camp

arrange for an e-transfer to finance@victoriaalliance.ca

Thank you! We look forward to seeing you on Monday, July 10th.