PLEASE READ ENTIRE FORM BEFORE COMPLETING, THEN MAIL OR E-MAIL COMPLETED PAGES 1 TO 5 TO ASSOCIATION DE NATATION BRIARWOOD Page 1 of 13
Briarwood Aquatic Day Camp 2018 Registration Form
Child’s Last Name and First Name / Child’s Date of Birth / M FParent’s/Guardian’s Name (Last, First) / Parent’s/Guardian’s Name(Last, First)
Home Phone / Work Phone / Home Phone / Work Phone
Street Address / Street Address
City, Province, Postal Code / City, Province, Postal Code
E-mail / E-mail
Emergency Contacts
Emergency Contact #1 (Last / First Name) / Emergency Contact #2 (Last / First Name)Home Phone / Work Phone / Home Phone / Work Phone
Street Address / Street Address
City, Province, Postal Code / City, Province, Postal Code
E-mail / E-mail
Pick-Up and Departure of Child from Camp
The following persons are authorized to pick-up and depart with my child, and these persons understand they may be asked to identify themselves prior to taking my child.
1.
2.
3.
X
Parent’s/Guardian’s Signature / Date
Medical Information and Authorization
Please list all special needs or requirements, or conditions such as epilepsy, asthma, hyperactivity, allergies, etc.Medication, Dosage and administration instructions / Medicare Card Number with expiry date
I agree to disclose all my child’s/children’s current and known medical conditions on this form, and I further agree I will disclose all my child’s/children’s medical conditions as they occur after the date of this application. For further clarity, I understand that Association de natation Briarwood, for the health and safety of others using the facility, requires immediate and ongoing disclosure of conditions like hand-foot-and-mouth disease, conjunctivitis, salmonella, lice, open wounds, and any condition which causes a rash or may be contagious.
I authorize the staff of the day camp to administer my child’s/children’s medication(s) in accordance with my instructions. I also authorize the staff of Association de natation Briarwood / Briarwood Swimming Association to provide first aid to my child if my child is injured and to summon emergency responders as well as transport by ambulance if first aid providers judge it is necessary. If no parent/guardian of my child can be reached in an emergency, I further authorize all medical and surgical treatments as may be performed or prescribed for my child by the attending physician and/or emergency responders.
X
Parent’s/Guardian’s Signature / Date
Aquatic Activities, Sun Protection and Photographs
I authorize my child to swim in all sections of
the swimming pool (subject to the control of the lifeguards and camp counsellors) / Yes No
I authorize Briarwood Aquatic Day Camp to apply, or help my child apply sunscreen / Yes No
I authorize Briarwood Aquatic Day Camp to take photographs and video of my child for promotional purposes / Yes No
X
Parent’s/Guardian’s Signature / Date
Acknowledgement of Risk and Terms
I, the parent/guardian of the child herein named, hereby apply for my child to attend Briarwood Aquatic Day Camp (the day camp) and to participate in the programs and use the services provided by Association de natation Briarwood. I have read, understood and agree to abide by the terms and conditions of day camp registration and enrolment, and all the rules and regulations of the day camp as set out in herein.
I understand and acknowledge that there are inherent risks and dangers in my child’s participation in these programs and the use of these services, and that the use of any equipment related to such activities may result in injury, illness or death, and damage to personal property. I understand that these risks may be attributable to, among other causes, the acts of other participants, accidents and force of nature.
I understand that if my child willfully damage(s) Association de natation Briarwood property, I am liable to pay for the damage, or make restitution in kind.
I have disclosed all my child’s medical conditions on this registration form, and I agree I will continue to disclose my child’s medical conditions as they occur after the date of this application. I understand that the day camp does not restrict food items brought by campers from home for their lunches or sold in its canteen, and that my child or children may therefore come in contact with traces of peanuts or other food allergens at camp.
I understand that the day camp is an outdoor summer camp, with many of its activities involving swimming and water sports, and my child will inevitably be exposed to the sun and may, despite all reasonable efforts, sustain sunburn. I understand that, while day camp staff will use all reasonable means to apply sunscreen periodically to my child or children, it is my responsibility to supply sunscreen and sun protection garments (hat, sunglasses, UV protective shirt) and to instruct my child when their gear must be worn, and that day camp staff will apply sunscreen to them periodically and remind them to wear their gear.
I acknowledge that I have read, understood and explained to my childall the rules and regulations of Association de natation Briarwood, Briarwood Aquatic Day Camp and Briarwood Pool as set out here and in the Briarwood Pool registration form. I understand and agree that I and my child must abide by said rules at all times we are on the property of Association de natation Briarwood. I acknowledge that if my child, after counselling, fail(s) to comply with the rules and take the direction of the lifeguards and day camp staff, my childmay be expelled as more fully set out in the 2018 Day Camp Rules and Regulations.
I agree that, should all day camp fees and registration fees not be paid in accordance with the deadlines set out in this application form, I will forfeit any amounts already paid as well as my day camp space. I understand that should my cheque be returned because of insufficient funds, because I have stopped payment, or for any other reason, I will be charged $40, and further payments must be made in cash in accordance with the deadlines set out in this application form, failing which my day camp space will be forfeit.
I declare that my child is at or above the minimum age of six (6) years required to register with the day camp, has graduated from kindergarten, and is physically capable of participating in the day camp programs, including aquatic instruction, offered by the day camp.
X
Parent/Guardian’s Signature / Date
2018 Day Camp Registration Worksheet
Early Bird
(expires 1 April) / Regular / Extended Hours / Week
WK / Dates / Mon / Tue / Wed / Thu / Fri / $85/wk / $95/wk / $30/wk / Total
1 / June / 25 / 26 / 27 / 28 / 28
2 / July / 2 / 3 / 4 / 5 / 6
3 / July / 9 / 10 / 11 / 12 / 13
4 / July / 16 / 17 / 18 / 19 / 20
5 / July / 23 / 24 / 25 / 26 / 27
6 / July/August / 30 / 31 / 1 / 2 / 3
7 / August / 6 / 7 / 8 / 9 / 10
8 / August / 13 / 14 / 15 / 16 / 17
9 / August / 20 / 21 / 22 / 23 / 24
Calculate the sum of all the weekly camp options chosen above
(Full 9 week season = Early Bird $765, Regular $855, Extended Hours $270) / (A)
PLUS: $50.00 Non-Refundable Registration Fee for each Camper / $50 (B)
PLUS: Mandatory Briarwood Pool family membership fee (one per family) / $150 (C)
Total Fees Due (A + B + C)
Payment Early Bird Rate (expires April 1)
½ of your Total FeesDue (payable before April 1, 2018) / Cheque #1
½ of your Total FeesDue (payable before June 25, 2018) / Cheque #2
OR
100% of your Total Fees Due (payable before April 1, 2018)
Payment Regular Rate (after April 1)
½ of your Total Fees Due payable immediately Cheque #1
PLUS: ½ of your Total Fees Due (payable before June 25, 2018) Cheque #2
Total Fees Due
Staff and volunteers will be available to register your child/children, and to receive payments on March 25, 2018 from 11:00 a.m. to 2:00 p.m. (1100 to 1400) at
Piscine Briarwood Pool
12421 rue Pavillon
Pierrefonds, QC H8Z 1M6
Please remember to bring your cheque book. We can process PayPal transactions on site. We also accept cash and issue receipts immediately.
Association de natation Briarwood / Briarwood Swimming AssociationBriarwood Aquatic Day Camp
2018 Day Camp Rules and Regulations
1. / Total Fees Due / The total amount of fees due is calculated on page 6 and is the sum of the following:
REGISTRATION: $50 non-refundable registration fee is required at the time of registration.
POOL MEMBERSHIP: All families enrolling children in Briarwood Aquatic Day Camp must be members of Association de natation Briarwood / Briarwood Swimming Association. Day camp families may join at a greatly reduced family rate of $150 (*minimum two weeks day camp registration).
WEEKLY CAMP FEES: $85/Wk (Early Bird) or $95/Wk (Regular)
EXTENDED HOURS (ADDITIONAL OPTIONAL): $30/WK
2. / 2018 Dates / The Day Camp opens on Monday, June 25, 2018 and closes on Friday, August 24, 2017. The duration of the camp is nine (9) weeks.
The Day Camp operates from 0800-1700 (8 a.m. to 5 p.m.) each day. Extended hours before and after regular hours are available for an additional fee (see below).
3. / Early Bird Rate
(until April 1, 2018) / The early bird rate is available for parents who register their children before April 1, 2018. The rate is:
- $85 per week per child
- Extended hours $30 per week additional (optional)
- Complete, sign and mail a registration form for each child to Briarwood’s postal address (at the end of this document)
- scan the completed registration form and return it by e-mail to o your form arrives no later than April 1, 2018.
Pay your early bird fees as follows:
FULL PAYMENT
- By cheque, your total fees due as calculated on page 6, mailed to Briarwood’s postal address so that Briarwood has it on or before April 1, 2018;
Access the Briarwood web site at and use the PayPal payment button to remit the full amount of your total feesdue on or before April 1, 2018.
PAYMENT IN INSTALMENTS
- Pay with two cheques: Cheque #1 for immediate deposit for ½ of yourtotal fees due, and Cheque #2, post-dated no later than June 25, 2018 for the balance of your total fees due, mailed to Briarwood’s postal address. Both cheques must arrive at Briarwood on or before April 1, 2018.
- Access the Briarwood web site at and use the PayPal payment button to remit ½ your total fees due no later than April 1, 2018 and also provide Briarwood, no later than April 1, 2018, with a cheque for the balance of your total fees due, post-dated no later than June 25, 2018, to Association de natation Briarwood. Please note that paying half your fees by PayPal without securing the second half of your fees with a post-dated cheque received by Briarwood on or before April 1, 2018means your registration is not complete.
4. / Regular Rate
(after April 1, 2018) / The regular rate, which applies after April 1, 2018, is:
- $95 per week per child
- Extended hours $30 per week additional (optional)
- Complete, sign and mail a registration form for each child to Briarwood’s postal address (at the end of this document)
- scan the completed registration form and return it by e-mail to .
Pay your fees as follows:
FULL PAYMENT
- By cheque, your total fees due as calculated on page 6, mailed to Briarwood’s postal address (see the last page of this document) to arrive no more than 5 days after you return your child’s registration form.
- Access the Briarwood web site at and use the PayPal payment button to remit the full amount of your total fees due at the time you register your child.
- Pay with two cheques: Cheque #1 for immediate deposit for ½ of your total fees due and Cheque #2, post-dated no later than June 25, 2018 for the balance of your total fees due,both mailed to Briarwood’s postal address to arrive no later than 5 days after you register your child
- Access the Briarwood web site at and use the PayPal payment button to remit ½ your total fees due at the same time you register your child, and also provide Briarwood with a cheque for the balance of your total fees due, post-dated no later than June 25, 2018, to arrive at Briarwood no later than 5 days after you register your child. Please note that paying half your fees by PayPal without securing the second half of your fees with a post-dated cheque received by Briarwood no later than 5 days after you register your child means your registration is not complete.
5. / Extended Hours / Extended hours are from 0700-0800(7 a.m. to 8 a.m.) and from 1700-1800 (5 p.m. to 6 p.m.) each day.
Fees for extended hours are $30 per week, payable no later than one week in advance.
Where a child is picked up late, there is a charge of $1.00 for each additional minute after 18:00 (6 p.m.) payable immediately upon pick-up.
6. / Drop In Rates / Children will be accepted on a daily basis for $35/day, always subject to space being available in the day camp. Extended hours for day campers paying the daily rate are an additional $5/day.
7. / Returned Cheques / A fee of $40 will be applied where a cheque is returned “not sufficient funds,” because payment has been stopped, or for any other reason. The day camper will not be accepted back in camp until a cash payment to replace the returned cheque plus the $40 fee is received by day camp staff in cash. Thereafter all fees must be paid in cash.
8. / No Refunds / Association de natation Briarwood / Briarwood Swimming Association is a non-profit organization, and its day camp program is short term, for an annual period of just nine weeks.
The hiring of staff and purchasing of program materials depends directly upon the numbers of registered children. For this reason, we cannot provide refunds once a child has been registered and a day camp space reserved for that child.
Changes to reserved weeks may be accommodated if there is sufficient space and staff. Please ask the day camp manager.
Space reserved for one child may not be transferred to another child.
9. / Day Camp and Pool Rules / All day campers are subject to the rules of the day camp, as herein set out, and the rules of the pool, as set out in the pool application form. Staff will inform parents and campers of the rules at the beginning of the season. If a child fails to comply with the rules after having been counselled, he or she is subject to immediate expulsion from the day camp.
If a child should be expelled, the day camp will retain the initial non-refundable registration fee together with 20% of the remaining pre-paid day camp fees.
10. / Personal Property / The day camp is not responsible for lost or stolen articles. Children should have their clothing and possessions marked for identification. Valuable items should not be brought to the camp. No electronic devices are to be brought to camp unless prior permission is obtained from the day camp manager.
11. / Food allergies / The day camp does not restrict the food items its campers bring from home for their lunches. Neither does the canteen restrict the food items it sells. Children may come into contact with peanuts or other food allergens while at camp.
12. / Authorized Pick-Up and Departure with Child / Only those persons who have been identified on the registration form may pick up and depart with the child. Persons wishing to enter the premises for the purposes of picking up a child may be subject to verification at the gate. Please see the Day Camp Manager if it is necessary to modify your registration conditions.
13. / 2018 Addendum: Rules and Regulations / For greater certainty, everyone who enters the premises of Association de natation Briarwood:
- Must follow all the rules of Briarwood Pool as set out in the Briarwood Pool application form;
- Must not damage or vandalize Association de natation Briarwood property, including but not limited to: Breaking or mishandling property, setting fires, killing or injuring wildlife, strewing garbage or failing to dispose of one’s own garbage in the bins provided, jumping or hanging on fences, hanging on the canopy or the supporting trestles, mis-using sporting equipment, or introducing damaging substances or objects into the plumbing system.
Checklist
1. / One day camp registration form completed and signed for each child.
2. / One family pool membership form completed and signed for each family.
3. / Payment:
- Have you included one cheque for full payment? or
- Have you included two cheques, each for ½ the amount of your fees? or
- Have you paid the total amount of your fees by PayPal through
- Have you paid ½ your fees through PayPal and enclosed a post-dated cheque for the balance owing?
3. / Mail the signed registration forms with your cheques to Briarwood’s postal address (to arrive on or before April 1, 2018 to qualify for Early Bird rate)
OR
4. / Scan and e-mail the registration forms to to reserve your place, and mail the signed registration form and cheques to Briarwood’s postal address (to arrive on or before April 1, 2017 to qualify for Early Bird rate):
Association de Natation Briarwood /
Briarwood Swimming Association
CP 46534
4930 boul. St-Jean
Pierrefonds, QC
H9H 5G9
PLEASE NOTE THAT REGISTRATION IS NOT COMPLETE UNTIL BRIARWOOD RECEIVES THE ORIGINAL SIGNED REGISTRATION FORM AND FULL FEE PAYMENT
27 March 2018