Гартуйсь!

Before beginning the registration process, please get the following documents ready: 1. Recent photo of your child – include your child’s full name on the picture. 2. Immunization record – include your child’s full name and health card number on the record.

CUAET Member*

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 choose Yes. **ONLY ACTIVE CYM CUAET FAMILIES MAY APPLY FOR THIS CAMP**.
If this does not apply to you, please choose No.

Yes

No

CAMPER INFORMATION

Campers Full Name*

First Name

Last Name

Photo Upload (most recent)*

The photo file name must include your child’s FULL NAME in English with the proper extension. Optional: include your child’s FULL NAME in English on the photo.

Типи файлів, що приймаються: jpg, gif, png, pdf, Макс. розмір файлу: 64 MB.

Date of Birth*

Gender*

Health Card # (OHIP)*

UYA Information*

Speaks Ukrainian*

Fluently

Fairly well

Poorly

Swimming Ability*

Good

Fair

Poor

T-shirt Size*

Pease choose your child’s t-shirt size from the drop down list below.

Comments – Special Requirements for Camper

Address*

Street Address Місто Province Postal Code

Home Phone*

Parent/Guardian Information

Parent/Guardian #1*

First Name Last Name Cell phone Work phone

Parent/Guardian #2

First Name Last Name Cell Phone Work Phone

MAIN CONTACT 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

5. EMERGENCY CONTACT INFORMATION

In Case of Emergency Contact*

First Name Last Name

Relationship to Camper*

Emergency Contact Address*

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

Will you be providing an immunization record?*

Please note: if you answered No to the question, for your child’s registration to be accepted, you will be required to upload a supporting document under the Immunization Record Section and/or to the Taborova Komisia.

Yes

No

Immunization Record*

Please include your child’s FULL NAME and HEALTH CARD number are visible on the immunization record.

Типи файлів, що приймаються: jpg, gif, png, pdf, Макс. розмір файлу: 64 MB.

Physician's Name*

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.

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

Please list any physical needs that require medical attention? (i.e. asthma, seizures, heart conditions, or other?)

Please list any immediate medical attention requirements.

Does the camper receive treatment or require support for behavioural issues? (i.e. requires 1:1 supervision)

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.
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.
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.
I hereby give permission for my son/daughter/camper 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 authorize 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 authorize the use of medical attention.

Declaration*

Camp Payments: Upon receiving a camp acceptance email from Taborova Komisia, I agree to pay all fees and charges for this camp by the due date, or as otherwise agreed to in writing by the Taborova Komisia.

I agree to pay all fees and charges

Data Collection:*

The information collected is for the purpose of planning and organizing activities for campers. 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 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 authorized 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.

If you are 18 and over, you are authorized to sign this form.

First Name

Last Name

Today's Date*

REGISTRATION CONFIRMATION MUST BE COMPLETED

Registration Email Confirmation*

Please enter your primary email contact to receive the Camp Veselka Registration Confirmation.

Enter Email Confirm Email

Email

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

ВИХОВНО – ВІДПОЧИНКОВИЙ ТАБІР 2024

OVERNIGHT CAMP REGISTRATION FORM – ВИХОВНО- ВІДПОЧИНКОВИЙ ТАБІР 2024

Гартуйсь!

CAMPER INFORMATION

Parent/Guardian Information

EMERGENCY CONTACT INFORMATION

UYA CAMPS ASSUMPTION OF RISK AND RELEASE FORMS

REGISTRATION CONFIRMATION MUST BE COMPLETED