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Our registration season is now open. 

Shade's Mills Summer Camp Registration

Section 1 - INFORMATION

*Please note four year olds must have attended JK in 2016/2017 to be eligible for the camp program.
Camper Information
Name(*)
Please let us know your name.

Address(*)
Please let us know your name.

City(*)
Please let us know your name.

Postal Code(*)
Please let us know your name.

Age at Camp(*)
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Grade in September(*)
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Date of Birth(*)
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Home Phone(*)
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Health and Medical Information
Campers Doctor(*)
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Phone(*)
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Campers Dentist(*)
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Phone(*)
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Custodial Parent/Guardian Information
Name(*)
Please let us know your name.

Home Phone(*)
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Work Phone
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Cell/Pager
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Email
Please let us know your email address.

Is there a Second Custodial Parent/Guardian?(*)
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Second Custodial Parent/Guardian Information
Name
Please let us know your name.

Home Phone
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Work Phone
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Cell/Pager
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Email
Please let us know your email address.

Emergency Contacts (if parents cannot be reached)
Name(*)
Please let us know your name.

Phone(*)
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Name
Please let us know your name.

Phone
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General Information
How did you hear about our camps? (Please check all that apply)(*)

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Brochure Location
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Other
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Section 2 - CAMP REGISTRATION

PLEASE TOTAL ALL COSTS
Camp Registration: In order to maximize the camp experience part time is not available. Extended Care Option: 7:30-9:00 a.m. and 4:00-5:00 p.m.
Week 5 July 31-Aug 4 (Nature Camp & Camper's Cooking: FULLY BOOKED. Email This email address is being protected from spambots. You need JavaScript enabled to view it. to be placed on the waiting list)
Week 6 Aug 8-11 Civic Holiday - Aug 7th (Nature Camp & Survival Camp 2: FULLY BOOKED. Email This email address is being protected from spambots. You need JavaScript enabled to view it. to be placed on the waiting list)
Week 7 Aug 14-18 Nature Camp & Fishing Camp are FULLY BOOKED email This email address is being protected from spambots. You need JavaScript enabled to view it. to be placed on the waiting list
Week 8 Aug 21-25 FULLY BOOKED email This email address is being protected from spambots. You need JavaScript enabled to view it. to be placed on the waiting list
OPTION 1: First week payment: I agree to make payment WITHIN 7 BUSINESS DAYS OF SUBMITTING THIS REGISTRATION for the first week of my child’s camp by one of the following methods: call YWCA offices to provide Visa/Mastercard information (519-267-6444); visit YWCA Cambridge at 55 Dickson Street to pay by cash, Visa/Mastercard, cheque or debit; or pay as prompted on line after I submit this form.

OPTION 2: Full Payment: I agree to make MY FULL PAYMENT WITHIN 7 BUSINESS DAYS OF SUBMITTING THIS REGISTRATION by one of the following methods: call YWCA offices to provide Visa/Mastercard information (519-267-6444); visit YWCA Cambridge at 55 Dickson Street to pay by cash, Visa/Mastercard, cheque or debit; or pay as prompted on line after I submit this form.
Payment(*)

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Please retain your receipts for tax purposes. There will be a fee of $25 to obtain a copy.
** Cancellations made without one week’s notice will be charged a 50% administration fee. All other cancellations will be charged 10% of the fee. Single day refunds will not be issued.
 

Section 3 - ABOUT YOUR CAMPER

We want your camper to enjoy his/her time at camp. Please provide us with the following information so that we can make her/his camp experience great. Information will remain confidential.
Please check ALL THAT APPLY
Please check words that best describe the first camper(*)

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Please indicate if your camper has any of the following
Seizures(*)
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Seizures - additional info
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Vision/Hearing(*)
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Vision-Hearing - additional info
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Mobility(*)
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Mobility - additional info
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ADHD(*)
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ADHD - additional info
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Asthma(*)
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Asthma - additional info
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Diabetes(*)
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Diabetes - additional info
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Dietary (*)
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Dietary - additional info
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Allergies(*)
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Allergies - additional info
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Is there any other health/medical information the camp staff should know about your child?
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Section 4 - PERMISSIONS

    Please READ CAREFULLY AND RESPOND TO ALL 5 SECTIONS
1. Photography:
I give permission for the YWCA to take photographs of my camper for the purpose of promotion and publicity of YWCA programs and services.
Photography Permission(*)
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2. Camp Readiness:
It is the intention of staff to provide a fun, safe camp experience for every child. Camp staff have been trained in a variety of behaviour management techniques to encourage positive behaviour and self-discipline. In instances where a child is causing harm to himself or to someone else or engaging in unsafe behaviour, staff may be required to intervene or remove the child from the situation. In order to support the success and safety of all campers, it is important that campers are "Camp Ready." The following criterion has been developed.
  • Camper is able to take direction and instruction from a staff member,
  • Camper is comfortable in and able to interact in a group environment,
  • Camper is able to participate in the camp program,
  • Camper is able to attend school successfully,
  • Camper interacts and participates in camp in a manner that is safe for themselves and others.
Campers that are attending a program and who are not demonstrating that they are "camp ready" may be withdrawn from the camp at the discretion of the Camp Director and/or the Director of Child Care Services.
I have read and agree to these terms.(*)
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3. Waiver of Claims:
I consent to allow my child to participate in the YWCA summer day camp program. I release any legal recourse against the YWCA and all claims resulting from personal injury. In the case of emergency, I authorize the YWCA to act on my behalf and transport my child to the nearest medical facility by ambulance or taxi at my cost. I understand that summer camps are nut-aware and I will refrain from including nut products in my child's snacks and lunches. I further understand that:
  • Camper's Cooking and Survival Camp involve use of fire.
  • Adventure's on the Water involves canoeing and rafting down the Grand River,
  • Outrageous Outings involves taking a school bus to a different off site field trip daily that includes but is not limited to physical activity such as rock climbing, mountain biking, use of water parks and swimming pools.
I have read and agree to these terms.(*)
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4. YWCA Day Camp Health and Emergency Procedures:
  1. If your camper becomes ill while at camp the staff will call you at the numbers listed on the Registration Form to come and pick her/him up. The decision to call will be based on the best interest of the camper as well as the health of the other campers. Please note that campers who have any of the following signs/symptoms will not be allowed to stay at camp: undiagnosed rash, vomiting, diarrhea or high fever.
  2. If your camper has a minor accident, the staff will administer emergency first aid and inform you to the incident upon your arrival. Should the Camp Director decide your camper would be better off at home she/he will contact you to come and pick up your camper before the end of the day.
  3. If your camper has an injury deemed more serious, she/he may be transported immediately by ambulance or taxi to the hospital at your cost. You will be called and asked to meet us there.
  4. It is YWCA policy to notify a parent by phone when a child sustains an injury to the head.
  5. In the case of severe weather conditions, all children and staff will remain inside the Nature Centre until the weather clears or parents arrive to pick up their campers
I have read and agree to these terms.(*)
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5. Summer Safety:
  1. This is an outdoor camp and campers often experience changes in the weather over their day. Please send extra clothes for rainy, damp days as well as a jacket/sweatshirt. Dressing your camper in layers will usually optimize comfort throughout the day.
  2. Running shoes only at camp please - sandals are not safe.
  3. Please send bug spray, lip balm and sun screen; labeling clearly with the camper's name.
  4. Please apply sunscreen before leaving your camper for the day. We will remind them to reapply after swimming and before the afternoon program under our supervision.
  5. Staff/volunteers will assist 4-5 year olds in their application of sunscreen.
  6. Programs are planned to allow for low energy, quiet activities in shady areas during the hottest time of the day.
  7. Campers and Counselors must wear sun hates at all times.
  8. Campers and Counselors must wear a t-shirt while swimming.
(*)
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Section 5 - Camper's Information Form

    (this information will be kept by the Counselor at all times)
Name(*)
Please let us know your name.

Gender(*)
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Height(*)
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Weight(*)
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Eye Colour(*)
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Hair Colour(*)
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Distinguishing Features
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Allergies/special medical information
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Camper can be released to (names and relationship)(*)
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  1. I have read and agreed to all terms and conditions as outlined in section 4.
  2. I have included a plan for payment information (section 2) WITHIN 7 BUSINESS DAYS OF SUBMITTING THIS DOCUMENT
I have read and agree to these terms(*)
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Thank you for taking the time to provide us with all proper information to ensure your camper is safe this summer!
If you have any questions please contact Kim Whalen at 519-267-6444.
I have read and agree to all terms.(*)
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Date Form Filled

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Recaptcha
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Contact Us

Monday-Saturday: 9 AM - 4 PM
(519) 267-6444

Contact us by email

55 Dickson Street
Cambridge, ON
N1R 7A5

About Us

As a member agency of YWCA Canada, YWCA Cambridge is part of a national movement known as the country’s oldest and largest women's multi-service organization, the largest national provider of shelter, literacy, life skills, employment and counselling programs, and is the second largest provider of childcare services in Canada.

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