forms* Go backYour message has been sent We are located at 110 Chemin Des Pins Blancs, Duclos, J0X 1S0. Please drive all the way up the driveway, there is room for you to turn around near the house. Name(required) (You can fill details of both children on one form, separate with commas) Warning Parent/Guardian Name(required) Warning Phone(required) Warning Emergency Contact # 1: Name and Phone(required) Warning Emergency Contact # 2: Name and Phone Warning Who will be picking up your child? Parent A Relative or Friend Warning If a Relative or Friend, please let us know their name and Phone Number. They will need to show some ID when they pick up your child/ren Warning Are there any allergies or medical concerns or medication we should be aware of? Yes No Warning If ‘Yes’, please let us know the details Warning We have an above ground pool on the property, it is gated and not easily accessed by younger children. Can your child swim? (Child #1 is the first child you list above) Child #1 – YES Child #1 – NO Warning Child #2 – YES Child #2 – NO Warning We do our utmost to ensure the safety of your child/ren. But should something happen, do we have permission to seek the appropriate emergency care? We will notify you immediately. YES NO Warning We live in a forest and there are ticks around. Our camp area and studio space is cleared and we do not walk through long grass or vegetation. But in the event your child does come into contact with a tick, do we have permission to remove it immediately, after speaking to you or leaving a message should we be unable to contact you? YES NO (You will be required to pick up your child) Warning I/We agree to the following: I/We allow our child/ren to attend Wood, Clay and Play Summer Camp located at 110 Chemin Des Pins Blancs, Duclos at their own risk and give permission for them to participate in the Studio and Outdoor activities laid out at Wood, Clay and Play Summer Camp. Any expenses and medical repercussions will be borne by the child’s family in the event anything occurs during the Wood, Clay and Play Summer Camp.I/ We hereby release Lorna Phillips, her heirs, assigns and all associated persons from liability and all claims for damages or sickness regarding any incident or injury sustained by my child in the studio and outdoor related activities and will not make claim against, sue or attach the property of 110 Chemin Des Pins Blancs, Duclos, Quebec and Lorna Phillips in any respect. (We will ask you to sign a copy of this form when you drop your child off) Agree Disagree Warning Warning. Submit Δ
lorna*phillips*art