July 10-14, 2017
Summer Day Camp
Registration Form
Completed forms can be delivered in person or mailed to:
3600 Vigo Road, Elmvale, ON Canada L0L 1P0
(705) 322-6321 or fax to 705-322-3575
www.wasagapaintball.com | [email protected]
CAMPER INFORMATION: (print clearly)
First Name:_________________________________________________
Last Name:_________________________________________________
Middle Name:_______________________________________________
Birthdate: day:_____ / month:______ / year:_______ Camper’s / Player’s Age on July 1st, 2017:_______________
Gender: [ ]Male [ ]Female
PARENTS / GUARDIANS:
Parent / Guardian: [ ]Mr. [ ]Mrs. [ ]Ms. [ ]Miss [ ]Dr.
First & Last
Name:______________________________________________________________________________________
Parent / Guardian: [ ]Mr. [ ]Mrs. [ ]Ms. [ ]Miss [ ]Dr.
First & Last
Name:______________________________________________________________________________________
Relationship:_________________________________________________________________________________
Home Mailing Address:__________________________________________________________________________
City/Town:_____________________________________ Province/State:__________________________________
Postal Code/Zip: ________________________________ Home Phone#: (_______)_________________________
Email: _______________________________________________________________________________________
Alternate Pickup authorization:
In the event that I/We are not able to pick up my/our child, he/she has my/our permission to leave with the following individual(s):
Name:_____________________________________________ Phone:(__________)_____________________________
Name:_____________________________________________ Phone:(__________)_____________________________
Notes:_______________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
CONDITIONS OF REGISTRATION & SIGNATURES: (read carefully!)
PHOTO RELEASE:
**Yes, I give permission to Wasaga Beach Paintball to include my child in photos taken by field staff, and/or occasional
videotapes taken by local media. I understand these photos may be used for promotional purposes (e.g. slide show, website
photo gallery, brochures, etc), but no names will be used.
** If you do not wish your child to be included in any photos, please print “Photos Prohibited” here:
[_________________________] and check here [ ] to indicate that your child is fully aware that he/she must exclude
themselves from any/all individual/group photos.
(Please note that other campers bring their own personal cameras and will take photos of each other throughout camp.)
CAMPER AGREEMENT:
We reserve the right to dismiss a camper who does not comply with our Field Safety Rules.
1.
Goggles must remain on at all times while in and around the playing fields. Never remove or lift your mask while
in the playing field.
2.
Barrel plugs must be in your paint guns before entering the safety area. Never remove your barrel plug while
outside the playing field.
3.
Paint guns may only be discharged while in the playing field. Never fire the gun outside the designated playing
area whether there is paint in the gun or not.
4.
Paintballs must be purchased from Wasaga Beach Paintball. Persons caught playing with non-field paint will be
asked to leave.
5.
Always handle paintball guns in a safe and responsible manner.
WAIVER AND RELEASE OF LIABILITY FORM
RELEASE OF LIABILITY, WAIVE OF CLAIMS, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
BY SIGNING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE
To: Wasaga Beach Paintball Adventure and 1533292 Ontario Inc.
Assumption of Risk:
1.
2.
I, the undersigned, wish to play Paintball and/or Airsoft and/or Laser Combat, and participate in go-karts, field sports, beach/swimming, I recognize and
understand that playing Paintball and/or Airsoft and/or Laser Combat and/or go-karting, field sports, beach/swimming (hereinafter called the “Game”)
involves certain risks. Those risks include, but are not limited to, the risk of injury resulting from possible malfunction of the equipment used in the
game and injuries from tripping or falling over obstacles in the game playing field. In addition, I recognize that the exertion of playing the game could
result in injury or death.
Despite these and other risks, and fully understanding such risks, I wish to play the Game and hereby assume the risks of playing the Game. I also
hereby hold harmless the “Sponsors” and indemnify them against any or all claims, actions, suits, procedures, costs, expenses (including attorney’s fees
and expenses), damages and liabilities arising out of, connected with, or resulting from my playing the Game, including without limitation, those
resulting from the manufacturers, selection, delivery, possession, use or operation of such equipment. I hereby release the Sponsors from any and all
such liability, and I understand that this release shall be binding upon my estate, my heirs, my representatives and assigns. I hereby certify to the
Sponsors that I am in good health and do not suffer from a heart condition or other ailment which could be exacerbated by the exertion involved in
playing the Game, I further certify that I am 18 years of age or older.
>> PLAYER/CAMPER OR GUARDIAN INITIAL (IF UNDER 18) >>
[________ ]
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT
In consideration of participating in the “Game”, I hereby agree as follows:
1.
2.
3.
4.
TO WAIVE ANY AND ALL CLAIMS that I have or may in the future have against Wasaga Beach Paintball Adventure and 1533292 Ontario Inc., their
directors, officers, employees, agents and representatives (all of whom are hereinafter collectively referred to as “the Releases”);
TO RELEASE THE RELEASEES from any and all liability for any loss, damage, injury or expense any cause whatsoever, INCLUDING NEGLIGENCE
ON THE PART OF THE RELEASEES;
TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability for any damage to property of, or personal injury to, any third
party, resulting from my participation in Paintball and/or Airsoft and/or Laser Tag or go-karts and/or field sports and/or swimming; and
That this Agreement shall be effective and binding upon my heirs, next of kin, executors, administrators and assigns, in the event of my death.
I HAVE READ AND UNDERSTOOD THIS AGREEMENT, AND I AM AWARE THAT MY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN
LEGAL RIGHTS WHICH I OR MY HEAIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNEES MAY HAVE AGAINST THE
RELEASEES.
>> Signature of Player/Camper >> __________________________________ Date: July __, 2017 to July__ , 2017
>> Print Full Name Clearly: ________________________________________________________________________
>> Guardian Signature (If under 18) >> ____________________________________________________________
>> Print Full Name Clearly: ________________________________________________________________________
FOR OFFICE USE
❑ Renter
GUN #: ___________
❑ Gun Owner
❑ Member
AMOUNT PAID: $____________
>> Witness Signature >> __________________________________________________________________________
CAMPER INFORMATION:
The following questions are optional. Please share any information that may help staff and counsellors in providing a
positive and meaningful camp experience for your child.
1) Is your child new to paintball? Does your child prefer RecBall (woodsball) or Tournament style paintball?
2) Hesitations / Fears:
a) Is this camper hesitant about any aspect of camp?
b) Does this camper have any serious fears?
3) Characteristics / Personal Habits:
a) What characteristics best describe this camper?
b) Is there anything that staff should be aware of regarding camper’s personal habits?
4) Interests / Goals:
a) What special talents/interests does this camper have?
b) What is the most important thing you hope this camp experience will do for this camper?
5) Notes / Other Comments:
PAYMENT:
Payments can be made by phone with your CC, online with PayPal or CC, by filling out your CC info below and scanning
into an email or in person at Wasaga Beach Paintball Adventure.
CREDIT CARD PAYMENT INFORMATION (Skip this step if paying by cash/debit or in person):
Credit Card Number:_____________________________________ CVD (3 digit number on back of card):_________
Expiry Date (MM/YYYY): _______/__________
Card Holder’s Signature: __________________________________
Card Holder’s Name (please print clearly):___________________________________________________________
Day Camp Fee: $349.00 + HST = $394.40
+
Early drop-off Required (between 8:00 and 8:30 am) [ ] yes [ ] no
If yes, what days & time? __________________
Late Pick-up Required (between 4:30 and 5:30 pm)
[ ] yes [ ] no
If yes, what days& time? ___________________
Extended Hours Fees: Morning $10/day
=
Evening $10/day x
+
# of Days ___________
Total Day Camp Balance Due (all fees payable in Canadian Funds):
$______________ Payment Method [ ] CC [ ] Interac [ ] Cash
[ ] Payment Received
[ ] Online with PayPal or your Credit Card @ www.wasagapaintball.com/day-camp
Campers can bring their own bag lunch & snacks. Please no foods containing peanut/nuts.
Lunches and snacks can be purchased at Wasaga Paintball.
Bug Spray and Sun Screen are HIGHLY recommended.
Camper Health Form
Please ensure it is filled out completely and accurately. Campers cannot attend camp without a current health form on file prior to camp.
CAMPER INFORMATION: (print clearly)
First Name:_________________________________________________
Last Name:_________________________________________________
Middle Name:_______________________________________________
Birthdate: day:_____ / month:______ / year:_______ Camper’s / Player’s Age on July 1st, 2015:_______________
Gender: [ ]Male [ ]Female
Camper’s Home Address:_________________________________ City/Town: _____________________________
Province/State:_________________________________________ Postal Code/Zip:_________________________
Home Phone# (______)___________________________ Alt Phone# (_________)_________________________
PARENTS / GUARDIANS & EMERGENCY CONTACTS: (print clearly)
(attach separate sheet of paper if necessary)
««« List in order who should be contacted in case of emergency – be sure to include parents/guardians: «««
1st Contact: [ ]Mr. [ ]Mrs. [ ]Ms. [ ]Miss [ ]Dr.
First & Last Name:________________________________________
Relationship:________________________________________
Home Phone: (_____)________________________________________
Work #: (_____)________________________________________
Cell/Pager: (_____)________________________________________
Cottage#: (_____)________________________________________
2nd Contact: [ ]Mr. [ ]Mrs. [ ]Ms. [ ]Miss [ ]Dr..
First & Last Name:________________________________________
Relationship:________________________________________
Home Phone: (_____)________________________________________
Work #: (_____)________________________________________
Cell/Pager: (_____)________________________________________
Cottage#: (_____)________________________________________
Camper Health Form (continued)
Last Name:___________________________ First Name:____________________________________
3rd Contact: [ ]Mr. [ ]Mrs. [ ]Ms. [ ]Miss [ ]Dr.
First & Last Name:________________________________________
Relationship:________________________________________
Home Phone: (_____)________________________________________
Work #: (_____)________________________________________
Cell/Pager: (_____)________________________________________
Cottage#: (_____)________________________________________
Camper’s Health Card #:____________________________________ Version Code:_____________
Out-of-Canada campers: indicate any medical plan, numbers & billing address, (attach separate piece of paper if necessary)
Family Doctor: Phone: (_____)________________________________________________________
Address: __________________________________________City:______________________________________
ALLERGIES: Be specific, attach separate page if necessary. If camper uses an Epipen, they must bring it to camp.
Indicate Type: Drug, Food, Environmental, Insect, Other Allergen (please be specific)
_________________________________________________________________________________________________________________
Type & Severity of Reaction (Indicate if life-threatening) Management / Treatment / Medication
_________________________________________________________________________________________________________________
ASTHMA: Does your child suffer from asthma? [ ]No [ ]Yes If yes, indicate severity? [ ]Mild [ ]Moderate [ ]Severe
What are the triggers for these attacks?_____________________________________________________________
MEDICATIONS:
Is camper currently on any medication (prescription or homeopathic)? If so, what?______________________________
How and when is this medication administered?_______________________________________________________
ACTIVITIES: Does your child have any physical, health, developmental, behavioural, or emotional condition that may
affect his/her ability to participate in camp activities? [ ]No [ ]Yes - If yes, give details:
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
***Parents will be responsible for any charges/expenses incurred to Wasaga Beach Paintball Adventure if their child
needs to be evacuated from an off-site trip, due to a medical or health condition that was not disclosed prior to their
child’s attendance.
I understand that failure to disclose pertinent information that could impact the safety of my child, or the safety of other campers
and staff, will result in the camper being sent home at the parent/guardian’s expense.
▪
To the best of my knowledge, my child is in good health. I will notify Wasaga Paintball if there is any change in my child’s
health, or he/she is exposed to any communicable disease within 3 weeks prior to arrival at camp.
▪
▪
In the case of medical emergency, I understand every effort will be made to contact parents or guardians. In the event I cannot
be reached, I hereby give permission to Wasaga Beach Paintball Adventure to hospitalize, secure proper treatment, order
injection, anesthesia or surgery for my child as named above.
I will submit any changes to this health form in writing to the camp prior to arrival.
>> Signature of Parent/Guardian:_____________________________________
Date:_____/______/______