Park Program Registration 2017  (Kindergarten - Grade 2)
Summer Youth Coordinator: Emma Pilkington
Phone: 403-749-3654
Email: sypcoordinator@gmail.com
Website: summeryouthprogram.weebly.com
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Parent/Guardian Name: *
Child's Name: *
My Child is Going into Grade:
Phone Number: *
Cell Phone Number: *
Email: *
Emergency Contact Name and Number: *
Name and phone number of individuals who are authorized to pick up your child:
Alberta Health Care Number:
Medical Information:
Does your child have any medical information that we should be aware of? (allergies, known illnesses, etc.)
Do we have your permission to take necessary medical action should your child become ill or injured during their participation in this program? *
Please indicate your preferred method of communication:
Please let 1 be your MOST preferred and 5 being LEAST preferred
1
2
3
4
Through our website
Facebook
Email
Phone call
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Permissions
I give my child permission to participate in all of the planned activities for the 2017 season. I hereby release this information and will not hold Delburne Family & Community Support Services responsible for any harm, or injury of any kind that may occur during my child's participation in this program. *
I agree to allow the release of photographs that may be taken of my child for the purposes of future program promotion as well as for use on the program’s Facebook page. *
My child will be participating in the following activities (please check off all that apply):
In order to meet staff to child ratios, scheduled parent volunteers are required on every trip and are expected to oversee a group of children. Admission for these volunteers will be paid for by the program. Volunteer opportunities are decided on a 'first come, first served' basis. It is expected that each family should provide a volunteer for a minimum of one event. In the section provided below, please indicate which event(s) you wish to volunteer for.
I wish to volunteer for the following activities:
Will volunteer
Will not volunteer
Mon July 3: Meet and Greet
Mon July 10: Anthony Henday Museum
Mon July 17: Fairytale Adventures
Mon July 24: Splish Splash Day
Wed July 26: Old MacDonald's Resort
Mon July 31: Yoga & Wellness in the Park
Fri August 11: Arts & Crafts with Seniors
Mon August 14: Scavenger Hunt
Wed August 23: BBQ Windup
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The program fee of $125 is required upon registration. Cash or cheques made out to "Delburne Village Office" can be dropped off at Village Office. Payments by debit are also accepted.
For other payment options please contact Emma at sypcoordinator@gmail.com or (403) 749-3654.
Registration deadline is Wednesday, June 28th. Please be advised that registration is not complete until payment is received. If payment is not received by the registration deadline a $25 late fee will be charged. Thank you for your understanding and cooperation.
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