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Airdrie Christian Academy

Summer Day Camp Registration

Summer Day Camp Registration

Summer Day Camp Registration

Step 1 of 3

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CAMPER INFORMATION
CHILD'S NAME*
First Last
DATE OF BIRTH*
Date Format: MM slash DD slash YYYY
AGE DURING CAMP*
GRADE ENTERING IN SEPTEMBER 2019*
GENDER*
- Male
- Female
Registration Date
Date Format: MM slash DD slash YYYY
Is this child a present student at ACA?*
- Yes
- No
I'm registering my child for*
- Grades 1 to 6 - $110 for the week
- Ages 3 to 5 - $80 for the week
Child 1: Grades 1 to 6
Price: $ 110.00 CAD
Child 1: Ages 3 to 5
Price: $ 80.00 CAD
I'm registering my child for*
- Grades 1 to 6 - $140 for the week
- Ages 3 to 5 - $90 for the week
Child 1: Grades 1 to 6
Price: $ 140.00 CAD
Child 1: Ages 3 to 5
Price: $ 90.00 CAD
MEDICAL INFORMATION

Please provide the following information to assist us in reacting appropriately and facilitating your children's needs or in the case of an emergency.
Alberta Health Care Number*
ANY ALLERGIES?*
- Yes
- No
If Yes, please list:*
HAS AN EPI-PEN?*
- Yes
- No
If Yes, please list:*
USE AN INHALER / PUFFER?*
- Yes
- No
If Yes, please list:*
IS ON MEDICATIONS?*
- Yes
- No
If Yes, please list:*
ANY OTHER CONDITONS?*
- Yes
- No
If Yes, please list:*
Please check the box beside the statement.*
- I acknowledge that in case of an injury to my children in which the school is unable to contact me that I authorize the school to engage the services of a doctor and/or ambulance as seems appropriate and agree to pay whatever fees are incurred in such cases.
REGISTER FOR ANOTHER CHILD?*
- Yes
- No
CAMPER #2 INFORMATION
CHILD'S NAME*
First Last
DATE OF BIRTH*
Date Format: MM slash DD slash YYYY
AGE DURING CAMP*
GRADE ENTERING IN SEPTEMBER 2019*
GENDER*
- Male
- Female
Is this child a present student at ACA?*
- Yes
- No
I'm registering my child for*
- Grades 1 to 6 - $110 for the week
- Ages 3 to 5 - $80 for the week
Child 2: Grades 1 to 6
Price: $ 110.00 CAD
Child 2: Ages 3 to 5
Price: $ 80.00 CAD
I'm registering my child for*
- Grades 1 to 6 - $140 for the week
- Ages 3 to 5 - $90 for the week
Child 2: Grades 1 to 6
Price: $ 140.00 CAD
Child 2: Ages 3 to 5
Price: $ 90.00 CAD
MEDICAL INFORMATION

Please provide the following information to assist us in reacting appropriately and facilitating your children's needs or in the case of an emergency.
Alberta Health Care Number*
ANY ALLERGIES?*
- Yes
- No
If Yes, please list:*
HAS AN EPI-PEN?*
- Yes
- No
If Yes, please list:*
USE AN INHALER / PUFFER?*
- Yes
- No
If Yes, please list:*
IS ON MEDICATIONS?*
- Yes
- No
If Yes, please list:*
ANY OTHER CONDITONS?*
- Yes
- No
If Yes, please list:*
Please check the box beside the statement.*
- I acknowledge that in case of an injury to my children in which the school is unable to contact me that I authorize the school to engage the services of a doctor and/or ambulance as seems appropriate and agree to pay whatever fees are incurred in such cases.
REGISTER FOR ANOTHER CHILD?*
- Yes
- No
CAMPER #3 INFORMATION
CHILD'S NAME*
First Last
DATE OF BIRTH*
Date Format: MM slash DD slash YYYY
AGE DURING CAMP*
GRADE ENTERING IN SEPTEMBER 2019*
GENDER*
- Male
- Female
Is this child a present student at ACA?*
- Yes
- No
I'm registering my child for*
- Grades 1 to 6 - $110 for the week
- Ages 3 to 5 - $80 for the week
Child 3: Grades 1 to 6
Price: $ 110.00 CAD
Child 3: Ages 3 to 5
Price: $ 80.00 CAD
I'm registering my child for*
- Grades 1 to 6 - $140 for the week
- Ages 3 to 5 - $90 for the week
Child 3: Grades 1 to 6
Price: $ 140.00 CAD
Child 3: Ages 3 to 5
Price: $ 90.00 CAD
MEDICAL INFORMATION

Please provide the following information to assist us in reacting appropriately and facilitating your children's needs or in the case of an emergency.
Alberta Health Care Number*
ANY ALLERGIES?*
- Yes
- No
If Yes, please list:*
HAS AN EPI-PEN?*
- Yes
- No
If Yes, please list:*
USE AN INHALER / PUFFER?*
- Yes
- No
If Yes, please list:*
IS ON MEDICATIONS?*
- Yes
- No
If Yes, please list:*
ANY OTHER CONDITONS?*
- Yes
- No
If Yes, please list:*
Please check the box beside the statement.*
- I acknowledge that in case of an injury to my children in which the school is unable to contact me that I authorize the school to engage the services of a doctor and/or ambulance as seems appropriate and agree to pay whatever fees are incurred in such cases.
REGISTER FOR ANOTHER CHILD?*
- Yes
- No
CAMPER #4 INFORMATION
CHILD'S NAME*
First Last
DATE OF BIRTH*
Date Format: MM slash DD slash YYYY
AGE DURING CAMP*
GRADE ENTERING IN SEPTEMBER 2019*
GENDER*
- Male
- Female
Is this child a present student at ACA?*
- Yes
- No
I'm registering my child for*
- Grades 1 to 6 - $110 for the week
- Ages 3 to 5 - $80 for the week
Child 4: Grades 1 to 6
Price: $ 110.00 CAD
Child 4: Ages 3 to 5
Price: $ 80.00 CAD
I'm registering my child for*
- Grades 1 to 6 - $140 for the week
- Ages 3 to 5 - $90 for the week
Child 4: Grades 1 to 6
Price: $ 140.00 CAD
Child 4: Ages 3 to 5
Price: $ 90.00 CAD
MEDICAL INFORMATION

Please provide the following information to assist us in reacting appropriately and facilitating your children's needs or in the case of an emergency.
Alberta Health Care Number*
ANY ALLERGIES?*
- Yes
- No
If Yes, please list:*
HAS AN EPI-PEN?*
- Yes
- No
If Yes, please list:*
USE AN INHALER / PUFFER?*
- Yes
- No
If Yes, please list:*
IS ON MEDICATIONS?*
- Yes
- No
If Yes, please list:*
ANY OTHER CONDITONS?*
- Yes
- No
If Yes, please list:*
Please check the box beside the statement.*
- I acknowledge that in case of an injury to my children in which the school is unable to contact me that I authorize the school to engage the services of a doctor and/or ambulance as seems appropriate and agree to pay whatever fees are incurred in such cases.
REGISTER FOR ANOTHER CHILD?*
- Yes
- No
CAMPER #5 INFORMATION
CHILD'S NAME*
First Last
DATE OF BIRTH*
Date Format: MM slash DD slash YYYY
AGE DURING CAMP*
GRADE ENTERING IN SEPTEMBER 2019*
GENDER*
- Male
- Female
Is this child a present student at ACA?*
- Yes
- No
I'm registering my child for*
- Grades 1 to 6 - $110 for the week
- Ages 3 to 5 - $80 for the week
Child 5: Grades 1 to 6
Price: $ 110.00 CAD
Child 5: Ages 3 to 5
Price: $ 80.00 CAD
I'm registering my child for*
- Grades 1 to 6 - $140 for the week
- Ages 3 to 5 - $90 for the week
Child 5: Grades 1 to 6
Price: $ 140.00 CAD
Child 5: Ages 3 to 5
Price: $ 90.00 CAD
MEDICAL INFORMATION

Please provide the following information to assist us in reacting appropriately and facilitating your children's needs or in the case of an emergency.
Alberta Health Care Number*
ANY ALLERGIES?*
- Yes
- No
If Yes, please list:*
HAS AN EPI-PEN?*
- Yes
- No
If Yes, please list:*
USE AN INHALER / PUFFER?*
- Yes
- No
If Yes, please list:*
IS ON MEDICATIONS?*
- Yes
- No
If Yes, please list:*
ANY OTHER CONDITONS?*
- Yes
- No
If Yes, please list:*
Please check the box beside the statement.*
- I acknowledge that in case of an injury to my children in which the school is unable to contact me that I authorize the school to engage the services of a doctor and/or ambulance as seems appropriate and agree to pay whatever fees are incurred in such cases.
REGISTER FOR ANOTHER CHILD?*
- Yes
- No
CAMPER #6 INFORMATION
CHILD'S NAME*
First Last
DATE OF BIRTH*
Date Format: MM slash DD slash YYYY
AGE DURING CAMP*
GRADE ENTERING IN SEPTEMBER 2019*
GENDER*
- Male
- Female
Is this child a present student at ACA?*
- Yes
- No
I'm registering my child for*
- Grades 1 to 6 - $110 for the week
- Ages 3 to 5 - $80 for the week
Child 6: Grades 1 to 6
Price: $ 110.00 CAD
Child 6: Ages 3 to 5
Price: $ 80.00 CAD
I'm registering my child for*
- Grades 1 to 6 - $140 for the week
- Ages 3 to 5 - $90 for the week
Child 6: Grades 1 to 6
Price: $ 140.00 CAD
Child 6: Ages 3 to 5
Price: $ 90.00 CAD
MEDICAL INFORMATION

Please provide the following information to assist us in reacting appropriately and facilitating your children's needs or in the case of an emergency.
Alberta Health Care Number*
ANY ALLERGIES?*
- Yes
- No
If Yes, please list:*
HAS AN EPI-PEN?*
- Yes
- No
If Yes, please list:*
USE AN INHALER / PUFFER?*
- Yes
- No
If Yes, please list:*
IS ON MEDICATIONS?*
- Yes
- No
If Yes, please list:*
ANY OTHER CONDITONS?*
- Yes
- No
If Yes, please list:*
Please check the box beside the statement.*
- I acknowledge that in case of an injury to my children in which the school is unable to contact me that I authorize the school to engage the services of a doctor and/or ambulance as seems appropriate and agree to pay whatever fees are incurred in such cases.

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PARENT / GUARDIAN INFORMATION
We are the*
- Parents
- Guardians
- Foster Parents
Marital Status of Parents*
- Married
- Widowed
- Separated
- Divorced
- Single
- Common Law
PARENT / GUARDIAN #1 INFORMATION
Parent / Guardian #1 Name*
First Last
Home Phone*
Cell Phone*
Work Phone
Mailing address*
Street Address City State / Province / Region ZIP / Postal Code
- Children live at this address
E-mail address*
Place of Employment*
Occupation*
I am the parent of these children by*
- Birth/Adoption
- Joint Custody
- Court Order
- Foster
- Guardianship
PARENT / GUARDIAN #2 INFORMATION
Parent / Guardian #2 Name
First Last
Home Phone
Cell Phone
Work Phone
Mailing address
Street Address City State / Province / Region ZIP / Postal Code
- Children live at this address
E-mail address
Place of Employment
Occupation
I am the parent of these children by
- Birth/Adoption
- Joint Custody
- Court Order
- Foster
- Guardianship
Custody Information (If applicable)

If there is a legal guardian, other than the above, please indicate:
Name
- Guardian
- Caseworker
Address
Street Address City State / Province / Region ZIP / Postal Code
Phone
Who has legal access to the student (in cases where an order exists)
If a custody or restraining order exists, a copy is required for the student’s file for the order to be enforced. Please indicate if any such order exists.
- Yes
- No
Upload the file here
Drop files here or
EMERGENCY CONTACT INFORMATION

At Airdrie Christian Academy, we always contact parents first if there is an emergency with your child. In the event we cannot reach you, please give us some emergency contacts.
As the legal parents/guardians of the children mentioned below, we give the following people as alternate contacts for our children in the event we cannot be contacted. We hereby authorize these people to be emergency contacts and/or pickup our child from Airdrie Christian Academy Day Camp as indicated below.
Please supply a minimum of 2 Emergency Contacts. Please include your Dayhome or Daycare provider if applicable.
Contact #1
Name*
First Last
Relationship to campers*
Phone # Type*
- Home
- Work
- Cell
Phone #*
Please indicate if they may also pick up your child*
- Emergency Contact
- May Pick up Child
Contact #2
Name*
First Last
Relationship to campers*
Phone # Type*
- Home
- Work
- Cell
Phone #*
Please indicate if they may also pick up your child*
- Emergency Contact
- May Pick up Child
Contact #3
Name
First Last
Relationship to campers
Phone # Type
- Home
- Work
- Cell
Phone #
Please indicate if they may also pick up your child
- Emergency Contact
- May Pick up Child

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Informed Consent and Waiver Agreement
I, the parent or guardian named on this registration, do herby agree to, and give permission for:*
- A) the children named herein to participate in the Airdrie Christian Academy Camp program (“the Program”) and assume all risk of loss, expense, damage or injury resulting from their participation in the activities of the Program, and
- B) do hereby give permission for staff members of Airdrie Christian Academy to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant(s).
I, the parent or guardian named on this registration, in consideration of Airdrie Christian Academy, registering the participant(s) in the program, undertake and agree as follows:*
- To waive any and all claims that I have or may have in the future have against Airdrie Christian, its staff members, Board of Governors, employees and volunteers, and their agents, representatives, successors and assigns (collectively referred to as the “Releasees”), and to release the Releasees of and from any and all losses, expenses, damages, and claims arising out of or in connection with injury or damage suffered by the participant(s) as a result of participating in the activities of the Program. And to indemnify and hold harmless the releasees from any and all liability for any losses, expenses, damages and claims arising out of or in connection with injuries or damage to any and all persons and to any and all property, in any way sustained or alleged to have been sustained, as a result of the participant(s) engagement in the activities of the Program. This release is effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives, in the event of my death or incapacity.
Please check the box beside the statement.*
- By signing below, I consent to having the information in this document collected by Airdrie Christian Academy. This personal information in being collected for the purpose of enrolling your child(ren) in the Program, to assign the child(ren) to the appropriate classes, to develop and nurture ongoing relationships with you and your children (ren) and to inform you of Program updates and upcoming opportunities at our school. Your personal information is protected under the Personal Information Protection Act in the Province of Alberta.
Please check the box beside the statement.*
- I have read and understood this agreement and I am aware that by signing this agreement I am waiving certain legal rights, which I or my heirs, next of kin, executors, administrator, assigns and representatives may have against the Releasees.
Signature of Parent or Guardian*
Date
Date Format: MM slash DD slash YYYY
Total
$ 0.00 CAD
How would you like to pay the fee?*
- Online with a credit card
- E-Transfer
When you submit the form it will redirect to the Paypal payment screen where you can make payment online with a credit card. No Paypal account is required.
E-Transfer payment can be sent to payments@airdriechristian.com. Use this password: TrustandObey. In the comments, please type “Summer Camp".

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