Camp and Program Waivers

Medical information

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

Parent/Guardian info

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.

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