Camp and Program Waivers

Participant name(Required)

First Last

Medical information

Please list any allergies, medication or other health information staff should be aware of.

School's Out Day Camps(Required)

December 22 (Young Artist of Beaumont)

December 23

December 29

December 30

December 31

January 2

Please select each program your child is registered for.

Parent/Guardian info

Parent/Guardian name(Required)

First Last

Address(Required)

Street address City Province Postal code

Parent/Guardian email(Required)

Phone number(Required)

Alternate phone number

Work/daytime phone

Alternate emergency contact

Please include another emergency contact in the event you cannot be reached.

Emergency contact name(Required)

Emergency contact relationship(Required)

Emergency contact phone number(Required)

Alternate phone number

Work/daytime phone

Waiver for activities

This waiver must be completed before attending any programs. Please read carefully. I understand the nature of the activity, the varying supervision provided and that there are inherent risks associated with this activity and that my child could sustain personal injury through participation in this activity, and I am hereby accepting to take that risk on behalf of my child. I hereby agree to save harmless and indemnify the City of Beaumont, its organizers, agents or employees against claims, expenses and demands in respect to injury or death arising out of myself or my child taking part in this activity, but limited to taking part in this activity.

I give permission for my child:(Required)

to participate in the programs identified.

Consent form

In the unlikely event of injury or an emergency, I consent to staff administering the following. If I don’t check these boxes, my child will not be given this assistance if needed.

Help with inhaler and/or epi pen

Ice to an injury

Pickup permissions

I give my child (8 years of age or older) to walk home alone before/after the program. I will not hold the City of Beaumont or any of its employees responsible for any incident, accident or mishap during my child's transit from one location to another.

I give permission for identified individuals to pick up my child from camp.

I do not give permission to the identified individuals to pick up my child from camp under any circumstances.

Please check off the applicable boxes. If none are selected, it is assumed the parent/guardian identified in the form is the only pickup option.

Individuals who are ALLOWED to pick up my child(Required)

Please list all individuals.

Individuals who are FORBIDDEN to pick up my child(Required)

Please list all individuals.

Parent or guardian's electronic signature(Required)

Please type your full name

The personal information collected is authorized under Section 4(c) of the Protection of Privacy Act and is managed in accordance with the Act. It will be used for administrative purposes directly related to registration in Community Programs and Camps, and may be communicated to relevant City business units and Alberta Health Services.
If you have questions about the collection or use of your personal information, please contact the Privacy Officer 780-929-8782.

Program registration

Camp and Program Waivers

Parent/Guardian info

Alternate emergency contact

Waiver for activities