Family Information

Parent/Guardian 1: Full Name *

Parent/Guardian 1: Phone *

Parent/Guardian 1: Email *

Would you like to receive information about upcoming family events from St.AW?

Parent/Guardian 2: Full Name

Parent/Guardian 2: Phone

Parent/Guardian 2: Email

Would you like to receive information about upcoming family events from St.AW?

Mailing Address: *

Address Line 1

City

State / Province / Region

Postal Code

Country

Emergency Contact Information

Emergency Contact Name *

Email *

Phone *

Indicate Bursary Request:

Please contact Rev Jen at j.cunnings@standrewswesley.com

Child(ren) Information

Child 1: Full Name *

Child 1: Birthdate: *

Child 1: Health Insurance #: *

T-Shirt Size (Child or Adult: S, M, L, XL): *

Child 2: Full Name

Child 2: Birthdate:

Child 2: Health Insurance #:

T-Shirt Size (Child or Adult: S, M, L, XL):

Child 3: Full Name

Child 3: Birthdate:

Child 3: Health Insurance #:

T-Shirt Size (Child or Adult: S, M, L, XL):

Please list any Dietary Restrictions / Medication / Special Needs the staff team should be aware of:

Parent/Guardian’s Agreement for: Liability Release and Waiver, Medical Permission, Photo and Video Release, Out Trip Permission St. Andrew's-Wesley United Church Arts Camp 2026.

IMPORTANT: By signing this document, you are waiving certain legal rights including your right to sue. PLEASE READ CAREFULLY.

Request to Participate: I hereby request my child(ren) to participate in Arts Camp 2026. *

INTIALS REQUIRED

Assumption of Risks Associated with the Event: I am aware that the Event involves participation in various activities typical to retreat settings. Programs might include swimming, hiking, outdoor play, visual arts, small group activities, etc. I understand that the foregoing does not list all of the risks or dangers and that participation in the Event involves risks and/or dangers which are not foreseen. I also understand that the risks or dangers associated with the Event involve a risk of injury to any and all parts of my child(ren) body which could result in serious personal injury, death and/or property loss. I hereby agree to freely and expressly assume and accept any and all risks to my child(ren), both foreseen and unforeseen, while participating in the Event. *

INTIALS REQUIRED

Liability Release and Waiver: In consideration of being allowed to participate in the Event, I hereby assume for my child(ren), any and all risks, dangers and hazards associated with the Event (including any risks, dangers or hazards which are unknown at this time) and hereby release and forever discharge The United Church of Canada, St. Andrew’s-Wesley United Church, PDC (who is the registered owner of the property), Camp societies, their directors, officers, employees and agents and any sponsor of the Event. I release their officers, directors, employees, contractors, subcontractors or agents during the Event from any and all liabilities, claims, demands, damages, actions, suits or causes of action, including any claims for breach of contract, negligence or gross negligence, statutory or other duties arising from the Event. *

INTIALS REQUIRED

Medical Permission: I give permission for any medical treatment necessary during the event for my child(ren). In the event that my child/youth is injured, ill or in need of medical attention (and I am unable to be contacted), I/we authorize the Leaders of the event to seek medical attention on my behalf. I give permission for the first aid person to administer over the counter medication to my child/youth if required. *

INTIALS REQUIRED

Photo and Video Waiver/Release: St. Andrew's-Wesley United Church is constantly updating their websites and promotional materials. We are proud of our programs and would like to be able to show pictures that demonstrate what we do. We take pictures during all our programs. We are asking for permission to use your image or your child/youth’s image (without their name) in promotional material, and on our websites to promote the benefits of our respective programs. I permit St. Andrew's-Wesley United Church to use my image or my child/youth’s image (in photograph, digital, video, or electronic form) for and in publications, posters, websites or other media, without limitation, and I agree not to make any claim for misappropriation of personality, breach of privacy, or other loss or damages against St. Andrew's-Wesley United Church. *

Parent/Guardian Out Trip Consent: Part of Art Camp is providing children with experiences that enrich and encourage them to share and learn. Field trips will be part of these activities, and they will be announced in advance at the beginning of the week. Would you allow your child to participate in these field trips, understanding that some degree of risk is inherent to any activity. OUT TRIP WAIVER I authorize my child/ren to participate in the field trips at St.AW Arts Camp. *

Acknowledgement:

I hereby acknowledge:

I have read and fully understand this Liability Release and Waiver, Medical Permission and Photo Waiver and Release Form and have signed this document of my own free act;
If I do not want to sign this document I can choose for my child(ren) not to participate in St.AW Arts Camp;
By signing this document I am giving up my right to sue anyone in relation to anything which happens to me or my child(ren) as a result of my participation in the Event;
This document binds me both me and any person who might stand in my place in the event of my injury or death, such as my family, heirs, executors, guardians or administrators;
This Document constitutes the final and entire agreement between myself and the persons and firms released by this Agreement.

Date *

Full Name: *

At: (City, Province) *

Financial Contribution

I agree to contribute $225 by either paying online with the below link or bringing in a cheque or cash to the office. If you selected a bursary option please contact Rev. Jen Cunnings at j.cunnings@standrewswesley.com *

I agree to pay online, or bring in cash/cheque
Contacting Rev Jen

PAYMENT LINK HERE

St.AW Arts Camp

Family Information

Emergency Contact Information

Indicate Bursary Request:

Child(ren) Information

Parent/Guardian’s Agreement for: Liability Release and Waiver, Medical Permission, Photo and Video Release, Out Trip Permission St. Andrew's-Wesley United Church Arts Camp 2026.

Acknowledgement:

Financial Contribution

Art

Apr 24

Community

Apr 22, 29 & May 6

Community & Art

May 3

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