Camp registration offline payment form – Fusion Toronto Services

Camper Information – Offline Payment form 2024

Step 1 of 3

Week #1 (July 8-12)
Week #2 (July 15-19)
Week #3 (July 22-26)
Week #4 (July 29-Aug 2)
Week #5: (Aug 6-9)
Week #6 (Aug 12-16)

Camper Information
Child's First Name*
Child's Last Name*
Gender*
- Boy
- Girl
Date Of Birth*
DD dash MM dash YYYY
Age*
Address*
Street Address City Postal Code
Home Phone*
Email to contact:*
School Name*
Health Card Number*
Behaviour Challenges?*
Does your child have any allergies?*
Permission to walk home?*
To whom may your child be released?
Father's Name*
Cell
Work
Email
Mother's Name*
Cell
Work
Email
Medical and Liability Waiver*
Every activity sponsored by Fusion Toronto is carefully planned and adequately supervised by mature adults. However, even with the best of planning and precaution, unforeseen events can occur. By submitting this form, the parent or guardian agrees to assume and accept the risks and hazards inherent in these related social activities. They also agree not to hold Fusion Toronto or its employees, or volunteers liable for damages, loss, or injuries to the person or property undersigned. The parents or guardians understand that they are signing for the minor listed on this form and the signature is for permission, medical, and liability release. “In the event that I cannot be reached in an emergency during the dates specified on this form, I hereby give my permission to the physician or dentist selected by Fusion Toronto to hospitalize, to secure proper treatment, and/or injection, anesthesia, or surgery for my son or daughter as deemed necessary.” I agree to the above Medical and Liability Release Waiver: I agree to the above Medical and Liability Release Waiver
- I agree to the above Medical and Liability Release Waiver
Picture Release Waiver*
- I agree to allow pictures of my child to be used for promotional purposes by Fusion Toronto. Names will not be displayed with photos of children