March Camp Forms | Branch Out

2022 March Break Adventure Camp

Creating Inclusive Social Opportunities for Kids

(Minimum numbers apply. If we do not meet our minimum we will reach out the Friday prior to your camp week beginning.

A full refund will be issued under these circumstances.)

Week 1: Monday, March 14nth to Friday, March 18th $255+GST/week

9am – 3pm Grades 1-4

Week 2: Monday, March 21st to Thursday, March 25th $255+GST/week

9am – 3pm Grades 1-4

*If your child does not fall into the above age categories, please contact us*

Please feel free to complete our online registration form or download the PDF and return to us via. email

March Adventure Camp PDF Registration

Child's name

Birthday

Parent/Guardian 1 ~Name

Email ~ Parent/Guardian 1

Phone ~ Parent/Guardian 1

Address ~ Parent/Guardian 1

Parent/Guardian 2 ~Name

Email ~ Parent/Guardian 2

Phone ~ Parent/Guardian 2

Address ~ Parent/Guardian 1

Fun facts about _________ (Please describe your child and some of their preferred activities and interests below)

Medical Information ~

All personal and medical information collected by Branch Out Learning and Behaviour Therapy in the registration package becomes part of the child’s record. It is considered confidential and is protected by our Confidentiality Policy. Email addresses provided by parents will be added to our confidential email list and will be used to enhance communication with parents in our program.

Doctor

Phone Number

BC Medical #

Diagnosis (If applicable)

Does your child require any additional supports, have any allergies, illnesses or other medical conditions? If so, please detail below.

Yes

Permission to call Ambulance

I (parent/guardian) give permission for Branch Out Learning and Behaviour Therapy to

call an ambulance in an emergency and agree to incur all costs.

Field Trip Permission

I (parent/guardian) give permission for Branch Out Learning and Behaviour Therapy to

take my child to outdoor activities within walking distance of the Max Turyk community centre.

Your Signature

Select a date

Your Signature

Media Release Branch Out Learning and Behaviour Therapy has permission to use photos of my child to promote the program publicly. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

Yes

Your Signature

Select a date