March Break 2022 Registration

Participant Information

Participant's Full Name *

Date of Birth *

Sex *MF

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code *

Parent's Information

Parent's/Guardian's Name *

Parent's/Guardian's Name

Email Address *

Email Address

Phone Number *

Phone Number

Alternative Emergency Contact

Primary Emergency Contact *

Phone Number *

Medical/Health Information

Please complete all fields as detailed as possible.

Medical/Health Conditions *

Treatment

Medications

Allergies *Please list all allergies.

EpiPen Required?

YesNoIf yes, you will be asked to complete and submit an anaphalaxis plan.

I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency.

Registration Terms and Agreements

Please read and check all sections to verify that you agree to our terms of registration.

Registration Agreement *

I have read, understand and agree to the terms of registration agreement.I have read, understand and agree to the terms of registration and enrolment in programs at Oak Learners and I have read and understand the policies and procedures laid out in the Parent Handbook.

Force Majeure Clause *

I have read, understand and agree to the Force Majeure Clause.All withdrawal requests made during a Force Majeure closure will be provided with a credit towards a future program registration. The lifetime credit can be used towards any future Oak Learners program registration and is transferable to any immediate family member.

Local Outings Consent *

I give permission for my child to go on local walking outings within 5km of Oak Learners.I release Oak Learners and individuals from liability in case of accident during activities related to regular programming, provided outlined safety procedures have been taken.Campers go on daily walking excursions and adventures in the local neighbourhood within a 5km radius of Oak Learners.

School Van Transportation Consent *

By checking this box, I hereby grant permission for my child (named above) to be transported in the Oak Learners’ Van during the week of Monday March 14 through Friday March 18.I agree to waive and release all claims, present or future, for damage, injury or loss to the student or the student’s or parent’s property which may be caused by any act, or failure to act, by the Oak Learners Inc, its administrative staff, teachers, employees, students, parents, or others acting on the school’s behalf and agree not to sue for relief arising from such claims.I release Oak Learners and individuals from liability in case of accident during activities related to transportation, provided normal safety procedures have been taken. Oak Learners has taken on the lease of a Kia Carnival minivan to provide safe pickup/drop-off services to certain schools, to provide van transportation to enrich our programs with field trips and to pickup students from local outings in the event of inclement weather or emergencies.

Photography Consent

I give full permission for the staff at Oak Learners to take photographs of myself or my child while under the care at our programs.I give consent for Oak Learners to share these pictures on the protected app SeeSaw for the week my child is attending camp.I give consent for Oak Learners to use these pictures for promotional purposes outside the program premises.For part of learning at our center, photographs will be taken to document our discoveries and experiences of the children. To protect the rights and privacy of the children in our programs, we require parental consent to share photos on the internal camp website and/or our promotional websites and media productions. Oak Learners agrees to never share children's names and/or personal information with their photographs.

Please type your name as your e-signature to certify that all information on this form is complete and accurate. *By typing your name in the box above, you are signing this form electronically. You agree that your electronic signature is the legal equivalent of your signature.