Гартуйсь!

1. Consent*

Welcome to the Ukrainian Youth Association Mandrivnyy Tabir online registration. Please fill out the registration form. The data entered by the user is private and confidential to the taboriva komisia up to and until camp begins. The information is disclosed to the camp senior staff including the medical staff. Please note that this online registration DOES NOT confirm a place for your child at camp. Once all forms are submitted, you will receive a confirmation email whether your child has been accepted, and you will be instructed how to submit payment. If you have any questions regarding registration, please email [email protected]

Thank you! Please continue with your registration. Taborova Komicia, Mandrivnyy Tabory

I agree to the terms and conditions and privacy policy of the registration.

CUAET ONLY Number of Attendees

If you are you a new immigrant that has arrived under the CUAET(Canada Ukrainian Authorization for Emergency Travel) program, and are a member of CYM, please indicate the number campers you will be registering. **ONLY ACTIVE CYM CUAET FAMILIES MAY APPLY FOR THIS CAMP* If this does not apply to you please skip over this entry.

Address*

Current Home Address

Street Address Address Line 2 Місто Province Postal Code

Home Phone*

Parent/Guardian Information

Parent/Guardian #1*

First Name Last Name Work phone Cell phone

Email*

Parent/Guardian #2

First Name Last Name Work Phone Cell Phone

Email

Child Custody Issues*

If there are child custody issues please provide details. Information is private and confidential to ensure the safety of your child.

YES

NO

Please list any child custody details.

EMERGENCY CONTACT INFORMATION

4. EMERGENCY CONTACT INFORMATION

In Case of Emergency Contact*

First Name Last Name

Relationship to Attendee*

Emergency Contact Address

Same as previous

Street Address Місто County / State / Region ZIP / Postal Code Країна

Home Phone

Cell Phone

Work Phone

Emergency Contact – Email*

MEDICAL INFORMATION

6. Medical Information

Medical Insurance Carrier*

Carrier Name

Policy Number

Group Number

Opting out of providing immunization records.*

For your child’s registration to be accepted you will need to provide details to the Taborova Komicia.

Yes

No

IMMUNIZATION & PHOTO FILE UPLOAD

CHILD #1 Upload CHILD's PHOTO and most recent IMMUNIZATION

Please ensure that your child’s health card number is visible on the form.

Макс. розмір файлу: 64 MB.

CHILD #2 Upload CHILD's PHOTO and most recent IMMUNIZATION RECORD

Please ensure that your child’s health card number is visible on the form.

Макс. розмір файлу: 64 MB.

Family Physician*

First Last

Physician's Phone Number*

Physician's Address*

Street Address Address Line 2 Місто County / State / Region ZIP / Postal Code Країна

Please list previous illnesses and/or operations.

Please list the campers name and any details.

Allergies & Required Medications (seasonal, insect, food etc…)

Please list the campers name and any details.

Does the camp attendee have any physical needs that requires medical attention? ( i.e. asthma, seizures, heard conditions, or other? PLEASE DESCRIBE:

Include your childs name and please list any medical information.

Does the camp attendee require immediate medical attention for any of the medical history provided?

Include your child’s name and please list any medical information.

Does the camp attendee receive treatment or require support for behavioural issues? (i.e. requires one-one supervision)

List campers name and support required.

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UYA CAMPS ASSUMPTION OF RISK AND RELEASE FORMS
Participants and Parents/Guardians for participants under 18 years of age are asked to read the following information carefully.

ASSUMPTION OF RISK AND RELEASE*

1. While every reasonable precaution shall be taken to ensure the safety and protection of your child, the UKRAINIAN YOUTH ASSOCIATION OF CANADA (CYM) (hereinafter called “UYA”), its Directors, Officers, Staff Members, Employees, Volunteers and all facilities used by the UYA to deliver its programs, are hereby released from all and any liability, in the event of loss of personal property or any accident or misfortune that may occur to your child.

I agree to the above.

CODE OF CONDUCT*

2. It is understood that should your child in any way endanger the safety and/or well-being of another individual or continually disrupt activities while attending a UYA Camp, said child will be immediately suspended from further participation in the camp program and parents will be required to take him/her home. Furthermore, fees paid will not be reimbursed.

I agree to the above.

AUTHORIZATION*

3. In signing this form, the parent or guardian certifies that the information correctly portrays your child’s medical profile and habits, and is amenable to necessary discipline if required.
4. The signature of the parent or guardian shall give the UYA and its Directors, Officers, helpers the right to arrange for any special services or other requirements necessary, in the best interest of your child and shall give the UYA the permission to obtain or approve medical interventions necessary for your child’s welfare and good health and the parent or guardian hereby agrees to pay for all such services as may be required as indicated above.
5. It is understood that in the course of UYA camp activity, pictures or recordings may be taken. I hereby authorize and release copyright to the UYA to use photographs, digital or other images in which my child appears, for UYA promotional or marketing purposes including UYA social media, brochures, newsletters, annual reports or UYA website.
6. I hereby give permission for my son/daughter/attendee to participate in field trips planned during all UYA outdoor adventure (hiking/canoeing) camps wherever they may be organized.

I agree to the above.

LIABILITY*

4.I, the undersigned parent/ guardian, assume full responsibility for payment of all camp fees and medical expenses not covered by insurance. I understand that I am liable for all costs related to, but not limited to damages caused by my child or children, or for additional costs incurred by the UYA as a result of my child’s or children’s actions, be they intentional or unintentional (tents, camping gear, canoes, etc.) outside of normal wear and tear. The safety of each individual is of the utmost importance to the UYA. In order to ensure the safety and well-being of all participants, the UYA reserves the right to alter the program at any time without compensation to participants, parents or guardians. Furthermore, my child has been made aware of rules and regulations as found in the Handbook for parents and campers, and has agreed to abide by them.

I have carefully read, understand and freely and voluntarily accept Assumption of Risk, Code of Conduct, Authorization and Liability information outlined above.

CONSENT TO MEDICAL ATTENTION*

5. I authorise the leaders in charge of the camp activities / excursions / events, for me and all those listed above to receive such medical or surgical treatment as may be deemed necessary, if we are incapacitated to give our consent and where it is impracticable to communicate with our Emergency Contact. I declare the information provided on this form is complete and correct. I understand that it is our responsibility to notify the Camp Administration of any changes to these details.

I authorise the use of medical attention.

Declaration*

Camp Payments:
I agree to pay all fees and charges for this camp by the due date, or as otherwise agreed to in writing by the Camp Organising Committee.

I agree to pay all fees and charges

Data Collection:*

The information collected is for the purpose of planning and organising activities for camp participants. It will be disclosed as appropriate to those conducting activities. This information will be kept securely and disposed of after the event. It is your responsibility to notify Mandrivnyy Tabir Taborova Komisia, and link email address [email protected]

I approve my information be kept for these purposes

Use of Image & Media Release Permission*

I give permission for photographs/videos/ images of the person / persons named previously, to be used without acknowledgement, remuneration or compensation, in various promotional materials authorised by the Ukrainian Youth Association, including but not limited to, programs, newsletters, posters, websites, social media, magazines, and newspaper articles.

I give permission

Electronic Signature*

Please fill in your first, last name and today’s date. This will be taken as a virtual signature to indicate you have completed each declaration and agreement in this form. It is considered a legal document.

All parties over the age of 18 must fill out this section.

First Name

Last Name

Date

REGISTRATION CONFIRMATION MUST BE COMPLETED

Registration Confirmation*

Please retype your email to receive confirmation that you have completed the ONLINE REGISTRATION.

Enter Email Confirm Email

Phone

This field is for validation purposes and should be left unchanged.

Mandrivnyy Tabir Registration Form

Мандрівний Табір – Mandrivnyy Tabir 2024

Гартуйсь!

CAMPER #1 INFORMATION

CAMPER #2 INFORMATION

Parent/Guardian Information

EMERGENCY CONTACT INFORMATION

MEDICAL INFORMATION

IMMUNIZATION & PHOTO FILE UPLOAD

UYA CAMPS ASSUMPTION OF RISK AND RELEASE FORMS
Participants and Parents/Guardians for participants under 18 years of age are asked to read the following information carefully.

REGISTRATION CONFIRMATION MUST BE COMPLETED

Mandrivnyy Tabir Registration Form

Мандрівний Табір – Mandrivnyy Tabir 2024

Гартуйсь!

CAMPER #1 INFORMATION

CAMPER #2 INFORMATION

Parent/Guardian Information

EMERGENCY CONTACT INFORMATION

MEDICAL INFORMATION

IMMUNIZATION & PHOTO FILE UPLOAD

UYA CAMPS ASSUMPTION OF RISK AND RELEASE FORMS Participants and Parents/Guardians for participants under 18 years of age are asked to read the following information carefully.

REGISTRATION CONFIRMATION MUST BE COMPLETED

UYA CAMPS ASSUMPTION OF RISK AND RELEASE FORMS
Participants and Parents/Guardians for participants under 18 years of age are asked to read the following information carefully.