Participant's Information *

First Name

Last Name

Phone *

(###)

###

####

Birthdate *

Birthdate

MM

DD

YYYY

Address *

Please include your building and unit # (if applicable)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Information *

First Name

Last Name

Phone

(###)

###

####

Media Release *

I authorize the Roywood Neighbourhood Centre (Training Institute of Ontario) to use all photographic and video images captured during the summer for whatever purpose the Institute approves. To ensure the privacy of individuals and children, images will not be identified using full names or personal identifying information without written approval from the photographed subject, parent or legal guardian. If you do not want us to use your photo or video, please email roywoodcommunity@gmail.com to let us know.

I hereby give permission for my child to be included in videos and/or photographs as they participate in all activities for the purpose of capturing, celebrating, and promoting the program (e.g. pamphlets, display boards, presentations, annual reports). *If participant is over 18, they can answer themselves.

Consent *

Unless over the age of 18, parents/guardians must be the ones to fill out this section.

I authorize my child to participate in the youth camp.