Sport Camp Participant Form

A Participant Form must be completed for each child attending MNP Community & Sport Centre Sport Camps. All information will remain confidential and only use for Sport Camps. We encourage all parents to submit an electronic participant form. On the first day of camp a separate waiver MUST be signed in person for each child. Waivers will be available upon sign in.

Participant Information

First Name *

Last Name *

Address *

City *

Province *

Postal Code *

Phone Number *

Date of Birth *

Age *

Height *

Weight *

Hair Colour *

My child is a member of Between Friends *

Yes

Sport Camp Information

Please specify what which Sport Camp your child is registered for: *

PD Camp

Spring Break Camp

Winter Break Camp

Will your child be needing Pre Care?

Yes

Will your child be needing Post Care?

Yes

Parent / Guardian Information

1. First Name *

1. Last Name *

1. Day Phone *

1. Alternate Phone *

1. Email *

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2. First Name

2. Last Name

2. Day Phone

2. Alternate Phone

2. Email

Emergency Contact Information

1. First and Last Name *

1. Relationship to Child *

1. Day Phone *

1. Alternate Phone *

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2. First and Last Name

2. Relationship to Child

2. Day Phone

2. Alternate Phone

Signout Permission

At the end of each day children must either be signed out by a parent/guardian. For security reasons, only parent/guardian and those listed below will be authorized to sign out your child. *PHOTO ID IS REQUIRED FOR SIGNOUT*

Other than the parent/guardian, I permit the following adults to sign my child out of MNP Community & Sport Centre Sport Camps:

1. First and Last Name

2. First and Last Name

3. First and Last Name

4. First and Last Name

I permit my son/daughter to sign him/herself out of MNP Community & Sport Centre Summer Sport Camps. I understand that once my child is signed out of the day camp, they will no longer be under the supervision of MNP Community & Sport Centre staff. ** Must be 12 years old or older**

Yes

N/A

Medical Information

The information on this form is being collected to enable us to manage and develop our business and operations. MNP Community & Sport Centre is committed to maintaining the accuracy, confidentiality and security of your personal information. MNP Community & Sport Centre endeavors to maintain physical, technical and procedural safeguards that are appropriate to the sensitivity of the personal information in question. These safeguards are designed to prevent your personal information from loss and unauthorized access, copying, use, modification or disclosure. For further information on our privacy policy please view our complete privacy policy on our website (www.mnpcentre.com)

Alberta Health Care # *

Has your child recently been in contact with any communicable diseases? *

Yes

If yes, please specify:

Does your child have any special needs or serious fears? *

Yes

If yes, please specify:

Does your child have any medical conditions, including allergies? *

Yes

If yes, please specify:

Does your child require any medication? *

Yes

If yes, please specify:

Please include additional information for your child, if necessary:

Medication Release

Medical Permission – No other medication, except which is listed below, shall be administered without my direct consent, except by trained medical staff. I give permission to the MNP Community & Sport Centre Sport Camp staff to aid my child in administering the listed medication(s) in an emergency situation. No other medication, except which is listed below, shall be administered without my direct consent, except by trained medical staff.

I give permission to the MNPCSC Sport Camp staff to aid my child in administering the listed medication(s).

Allergy/Condition

Medication

Dosage

When/How to Administer

Additional Comments

Image Release

My child has permission to participate in media coverage and photographs of camps, which may be taken for media or marketing purposes at MNP Community & Sport Centre.

I hereby grant MNP Community & Sport Centre the right and permission to publish moving composite reproductions for the purpose of, without limitation, television, publications, and any trade or advertising purposes. Accordingly, I release and discharge MNP Community & Sport Centre & Lindsay Park Sports Society (LPSS) from any liability by virtue of blurring, distortion, alteration, optical illusion or use in composite form that may occur or be produced in taking of said picture(s) or any processing through completion of the finished product.

Image Release Agreement *

I AGREE to the above Image Release terms and conditions.

I DISAGREE to the above Image Release terms and conditions.

Full Name of Parent/Guardian permitting Image Release *

WAIVER FORM

CONSENT, RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISK and INDEMNITY

In consideration for permission, granted now or in the future by MNP Community & Sport Centre and Lindsay Park Sports Society (LPSS) for the Participant to participate in Summer, Spring or PD Sport Camps.

I/we, as the parent(s)/guardian(s) of the Participant agree and acknowledge that:

The Participant has met all of the prerequisites required for participation in the activity(s).

The Participant will abide by the rules and regulations imposed on the participants in the activity(s).
There are risks and hazards inherent in the very nature of the activity(s) and that as a result of these risks and hazards, the Participant, may suffer personal injury, even death, as well as property loss. Depending on the Camp, activity(s) may include: badminton, baseball, circuit and strength training, dance, diving, floatables, gym and outdoor games, sports, gymnastics, indoor and outdoor cycling, nutrition education, obstacle courses, running, walking trips, swimming, trampolines, yoga, bouncy castle and outdoor skate park. I am aware and understand the risks and hazards associated with the activity(s) and may be present in the activity(s) and that the Participant is assuming the risks and hazards at his or her own risk.
I waive any claim the Participant or I may have against MNP Community & Sport Centre and Lindsay Park Sports Society (LPSS) and any and all instructors, coaches and organizers of the activity(s) and their respective heirs, representatives, successors and assigns from all claims, demands, costs, expenses, actions and causes of action arising from the Participant's involvement in the activity(s) and agree to indemnify and hold harmless the City of Calgary for any claim, including any claim for medical services arising from the Participant's involvement in the activity(s).
MNP Community & Sport Centre and Lindsay Park Sports Society (LPSS) may secure such medical advice and services as it, in its sole discretion, may deem necessary for the Participant's health and safety and I shall be financially responsible for such advice and services. I understand that MNP Community & Sport Centre and Lindsay Park Sports Society (LPSS) do not provide accidental death, disability, dismemberment or medical expense insurance on behalf of the participants in the activity(s) and therefore agree to assume responsibility for such insurance coverage for the Participant.
I agree that in the event that any provision of this form is held to be invalid and unenforceable by any court of competent jurisdiction, the invalidity or unenforceability of such provision will not affect the remaining provisions of this form, which shall continue to be enforceable.
This CONSENT, RELEASE OF LIABILITY, WAIVER OF CLAIM, ASSUMPTION OF RISK and INDEMNITY is binding on the Participant and I, and our heirs, executors, administrators, personal representatives and assigns.

WE HEREBY ACKNOWLEDGE READING, UNDERSTANDING AND AGREEING WITH THE FOREGOING.

Waiver Agreement *

I AGREE to the above Waiver Form terms and conditions.

I DISAGREE to the above Waiver Form terms and conditions.

Full Name of Parent/Guardian permitting Waiver Form Terms & Conditions *

Should you wish to retain a copy of this signed form, you need to print it before clicking the ‘submit’ button below. If you do not print, but, at a later date wish to attain a copy of the signed form, then please send an email request to drylandregisteredprograms@mnpcentre.com.

Thank you.

Leave this field blank

Participant Information

Sport Camp Information

Parent / Guardian Information

Emergency Contact Information

Signout Permission

Medical Information

Medication Release

Image Release

WAIVER FORM

MNP Community & Sport Centre

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