Blainville Day Camp Form

Fill out the form below before your online registration!

Child Info

First Name

Last Name

Birth Date

Medical Insurance No.

Expiration Date

Parent Info

First Name

Last Name

Phone (cell)

Phone (work)

Important Notes

Other person authorized to come pick them up:

In case of an emergency, who should be contacted if the parents are not available

Last Name

Relation to parent

Phone (cell)

Phone (work)

Medical Information

Allergies

Do they have an epipen with them?

Yes No

Health or medical conditions

Do they take any medication?

Acceptations

Acceptation of the terms and conditions

Only information concerning the participant's state of health will be disclosed to his monitor and his immediate superior in order to allow a better approach, as well as a more effective intervention in the event of an emergency.

I hereby authorize O-Volt to provide first aid to the participant. If the officials deem it necessary, I also authorize them to transport my child by ambulance in case of an emergency.

I am responsible for informing camp officials in writing of any changes to the information written in this form.

I authorize O-Volt to take photos and videos during the day camp for promotional content.

Blainville Day Camp Form

Fill out the form below before your online registration!

Child Info

Parent Info

Important Notes

Medical Information

Acceptations

Blainville

Sherbrooke

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