TRACKS Youth Program
Trent Aboriginal Cultural Knowledge and Science
1600 West Bank Drive Telephone
Peterborough, ON Canada K9J 7B8
Phone (705) 748-1011 x 6381
Facsimile (705) 748-1569
E-mail trackscamp@gmail.com
Web www.trackscamp.wordpress.com
Registration/Waiver Form- July 27-July 31 Ages 12-15
Cost: $175.00
9am-3pm daily. Pick up/drop off at the Tipi, Gzowski College parking lot, Trent U.
Camper:
Name: _______________________________________________
Address: _____________________________________________
Town/City: _________________________________
Province: ______________________ Postal Code: ________________________
Phone: (_____)_____-________________
Email: ____________________________________________________
Payment Method : ______________________ Enclosed : ______ Will Pay : ______
(Are you paying by cash or cheque? Is payment enclosed or will we receive it later?)
Guardian/Emergency Contact:
Name: ___________________________________
Phone: (_____)_____-________________
Relationship to Camper: ________________________
I have read, understand, and agree to the terms outlined in the policies outlined in this
registration package (Packing List, Policies, Discipline Policy).
____________________________
Camper’s Signature
________________________
Date
____________________________
Guardian’s Signature
________________________
Date
TRACKS Youth Program
Trent Aboriginal Cultural Knowledge and Science
1600 West Bank Drive Telephone
Peterborough, ON Canada K9J 7B8
Phone (705) 748-1011 x 6381
Facsimile (705) 748-1569
E-mail trackscamp@gmail.com
Web www.trackscamp.wordpress.com
Health Information Form
The information collected on this form will only be used to assist TRACKS staff should a
medical emergency arise. In accordance with applicable Privacy Legislation, this
information will be shared with medical personnel only (in the case of an emergency),
and will not be used for any other purpose.
Camper’s Full Name: ______________________________
Date of Birth: ___________ (dd/mm/yy)
Gender (circle one): Male
Female
Does not identify
Do you have any food allergies or dietary restrictions?
____________________________________________________________________
Are you allergic to bee stings or other insect bites?
____________________________________________________________________
Are you allergic to wood smoke, plants, molds, or other substance which may be
present in an outdoor setting?
__________________________________________________________________
Do you have any medical condition(s) about which we should be aware? (eg: asthma,
diabetes/hypoglycemia, current illness). Describe more on a separate page if needed
__________________________________________________________________
Do you take any medications about which we should be aware? If yes, please list them
and describe what they are for: ____________________________________________
______________________________________________________________________
Who is the person/people who are authorized to pick your child up from camp?
______________________________________________________________________
______________________________________________________________________
Please contact us by phone or email if this changes
On a separate page or via email, please inform us of any physical, mental, or
behavioral issues your child might have, including any learning challenges
TRACKS Youth Program
Trent Aboriginal Cultural Knowledge and Science
1600 West Bank Drive Telephone
Peterborough, ON Canada K9J 7B8
Phone (705) 748-1011 x 6381
Facsimile (705) 748-1569
E-mail trackscamp@gmail.com
Web www.trackscamp.wordpress.com
Packing List & Policies
Things to pack:
BACKPACK! (We walk often, so it’s important that campers have their hands free!)
Hat & Sunscreen
Reusable water bottle with water
Lunch + 2 snacks
Running shoes- no sandals!
Rain gear, and extra clothes in case of rain
Extra layers- it can get cool in the woods and in the university, which is air conditioned.
Attire
All camps have outdoor and nature play scheduled. Your child must wear clothing
suitable for outdoor activities and play (i.e- shorts, leggings, sweatpants…no skirts or
dresses.) Suitable enclosed toed footwear is required for many activities (no flip flops).
Sandals are not allowed for lab-based and some outdoor activities.
Lunch
Please pack a healthy litterless lunch (if possible) and two snacks each day. Ensure that
your child has sufficient liquids to keep them hydrated while playing outdoors. We
suggest that your child uses an ice pack or an insulated lunchbox as we will be outside
most of the day. Glass containers are not recommended. For the security of your
children, please avoid sharp utensils.
**TRACKS is a nut-free environment for the safety of all staff & campers**
Sun Protection
Please apply sunscreen prior to the start of each day & ensure your child brings
sunscreen & a hat to camp. Sun safety is extremely important. We require that your
child cooperate in protecting themselves from injury by wearing sunscreen and a hat for
all outdoor activities.
Electronic Devices
We are not responsible for lost/damaged/stolen items. We encourage campers to leave
all valuable objects (including cell phones) at home. (Electronic items will not be
permitted throughout the day).
Contacting campers during Camp Days
The Camp Director will have a cell phone throughout each camp day. Parents and
guardians will be provided with these phone numbers on the first day of camp.
TRACKS Youth Program
Trent Aboriginal Cultural Knowledge and Science
1600 West Bank Drive Telephone
Peterborough, ON Canada K9J 7B8
Phone (705) 748-1011 x 6381
Facsimile (705) 748-1569
E-mail trackscamp@gmail.com
Web www.trackscamp.wordpress.com
Discipline Policy
In order to have a great summer, TRACKS Camp needs to have rules for the campers.
Respect is important for everyone and disrespectful behaviour will not be tolerated. No
verbal or physical abuse towards other campers or to the camp staff will be tolerated.
For any behaviour that threatens the well-being of campers & staff (e.g. violence,
threatening or unsafe behaviour) we hold the right to remove campers
immediately from all further camp activities.
Payment/Refund Policy
We hope that nothing prevents your young TRACKer from joining us at camp!
We do recognize that things come up and want to be flexible and understanding in our
approach to cancellations. However, we never want to turn campers away, and last
minute cancellations open up a space that could have been filled by an eager camper.
To address this, the following policy is in place.
Payment must be received (along with any subsidy forms if applicable) at least a week
before the start of camp to reserve your camper’s spot. If payment has not been
received or communication made to address that, TRACKS reserves the right to give
your camper’s spot away to anyone on the wait list.
If you realize that your camper cannot make it (previous commitments, unforeseen
circumstances, etc.) please let us know at least a week before camp. We will issue a full
refund or return any cheques or money that have not yet been deposited. For any
cancellations occurring with less than a week’s notice, we cannot guarantee a refund.
TRACKS reserves the right to make exceptions for unforeseen emergencies outside the
control of the family and will examine each situation on a case-by-case basis.
If a camper voluntarily decides not to come back to camp, or family decides not to send
their camper back, TRACKS will not issue refunds. If camp is not meeting your
expectations of if there are any issues with other campers or staff, TRACKS will work
with families and campers to try to resolve these issues using whatever means possible.
We encourage open dialogue and ask families and campers to please approach us with
any issue before it becomes an overwhelming problem. This discussion can happen
directly with an Instructor or be brought up with our Program Coordinator. If necessary
an outside person can be brought in to mediate.
TRACKS Youth Program
Trent Aboriginal Cultural Knowledge and Science
1600 West Bank Drive Telephone
Peterborough, ON Canada K9J 7B8
Phone (705) 748-1011 x 6381
Facsimile (705) 748-1569
E-mail trackscamp@gmail.com
Web www.trackscamp.wordpress.com
Photo Permission Form
Dear Parent,
We are so pleased to offer the TRACKS Youth Program Activities with the support of
Trent University and the Kawartha World Issues Centre. We would appreciate your
permission to provide TRACKS Youth Program with photographs, videotapes and/or
recordings of your child at camp for promotional and fundraising purposes. We thank
you for your cooperation and ask that you please complete the following consent form
based on your preference. Please note that participant’s names will never be used in
conjunction with the photographs.
By signing this consent, I give permission for TRACKS Youth Program, to take photos,
video and audio recordings (referred to as “images”) of my child and to allow TRACKS
Youth Program to copy, modify and distribute, including the right to allow other parties
to do the same, those images that include your child in whatever appropriate way either
of TRACKS Youth Program sees fit without having to seek further approval.
I hereby waive any right to inspect or approve the finished photograph or printed matter
that may be used in conjunction therewith, or to the eventual use that it might be
applied. I hereby release, waive and forever discharge TRACKS Youth Program of and
from all claims and demands whatsoever which I may have arising out of their use of
the said photograph(s).
Please select one of the two options below:
 I have read the foregoing release, authorization and agreement, before affixing my
signature below, and warrant that I fully understand the contents thereof.
 I do not wish for TRACKS to the use of my child’s photographs, videotapes and/or
recordings.
Name of Participant: _______________________
____
Name of Parent/Guardian (please print):
Parent/Guardian Signature:_______________
Date: Day: ________
Month:
__________
Year: 2015
RELEASE OF LIABILITY, WAIVER OF CLAIMS
ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT
BY SIGNING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE
RIGHT TO SUE. PLEASE READ CAREFULLY!
TO: THE GOVERNORS OF TRENT UNIVERSITY
NAME OF PARTICIPANT: __________________________________________________________________
ADDRESS OF PARTICIPANT: ______________________________________________________________
EVENT:
ASSUMPTION OF RISK
I am aware that participating in the activities of TRACKS Youth Program camp at Trent University
from July 27-31 2015 has inherent risks, including but not limited to:
-any manner of injury, including death, resulting from use, misuse, non-use and failure of any equipment,
including vehicles, laboratory materials, and other activity materials
-environmental hazards (allergies, interaction with wildlife, exposure to hazardous substances etc)
- natural hazards resulting in death, injury or property damage (weather, terrain, fire etc).
-negligence or criminal acts of others
-theft, vandalism, or loss of personal or intellectual property
- risks associated with activities on Trent University grounds and woods, including getting lost,
environmental hazards (heat, dehydration, poison ivy, animal bites) and increased chance of trips and
falls
- risks including injury or death due to mishandling of hazardous materials and/or failing to follow the
instructors directions during laboratory and other activities
I freely accept and fully assume all such risks, dangers and hazards and the possibility of personal injury,
death, property damage or loss, pertaining to the TRACKS Youth Program camp at Trent University
from July 27-31 2015.
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT
In consideration of Trent University allowing me to hold the TRACKS Youth Program camp at Trent
University from July 27-31 2015 on University property, and other good and valuable consideration, the
sufficiency and receipt of which is irrevocably acknowledged, I agree as follows:
1.TO WAIVE ANY AND ALL CLAIMS that I have or may have in the future against the TRACKS Youth
Program, the Kawartha World Issues Centre, and Trent University, their governors, officers, employees,
students, agents, volunteers and independent contractors, (all of whom are hereinafter collectively
referred to as the Releasees);
2.TO RELEASE THE RELEASEES from any liability for any loss, damage, death, injury or expense that I
may suffer, or that my next of kin may suffer, as a result of my participation in TRACKS Youth Program
activities, INCLUDING, BUT NOT LIMITED TO, NEGLIGENCE, BREACH OF CONTRACT, OR BREACH
OF ANY STATUTORY OR OTHER DUTY OF CARE.
3.TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability for any damage to
the property of, or personal injury to, any third party, including death, resulting from my participation in
TRACKS Youth Program activities and
4.This agreement shall be effective and binding upon my heirs, next of kin, executors, administrators,
assigns and representatives in the event of my death or incapacity.
In entering into this Agreement, I am not relying upon any oral or written representations or statements
made by the Releasees other than what is set forth in this Agreement.
I HAVE READ AND UNDERSTOOD THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS
AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE, WHICH I
OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE
AGAINST THE RELEASEES.
Signed this ____________ day of _____________________________________, 2_______.
__________________________________
NAME OF PARTICIPANT
____________________________________
SIGNATURE OF PARTICIPANT
__________________________________
NAME OF PARTICIPANT’S
PARENT OR GARDIAN
____________________________________
SIGNATURE OF PARTICIPANT’S
PARENT OR GARDIAN
__________________________________
NAME OF WITNESS
____________________________________
SIGNATURE OF WITNESS
This agreement must be completed in full, signed, dated, and witnessed before the participant
may participate in the TRACKS Youth Program camp at Trent University from July 27-31 2015.