Winning Circle | Day Camp Enrollment

Child Information

Name(Required)

First Initial Last

Gender(Required)

Male

Female

Birth Date(Required)

School/Grade

Address(Required)

Street Address Address Line 2 City Province Postal Code

Parent(s)/Guardian(s) Information

1.(Required)

First Name Last Name

Relationship to Child

Cell Phone

Work Phone

Home Phone

Email Address

Enter Email Confirm Email

2.

First Name Last Name

Relationship to Child

Cell Phone

Work Phone

Home Phone

Email Address

Enter Email Confirm Email

Emergency Contact(Required)

First Name Last Name

Relationship to Child

Cell Phone

Work Phone

Home Phone

Custody

Mother

Father

Both

Child's primary residence

Mother

Father

Both

Health Information

Does your child have any health concerns, including the following, that may impact their participation in the program?

Social

Health Issues

Medications

Allergies

Special Needs

If yes, please specify:

Please Provide Health Card #

Medication

We do not administer any medication with exception of emergencies. Complete this section if this applies.

Is your child taking any medication (oral, injection, inhaler, or Epipen ) and/or have any life threatening allergies?

Yes

No

Upload Photo

Accepted file types: jpg, jpeg, png, gif.

Name of medication

Date

Time

:

Dosage

Tables/Tsp

How to apply

Orally

Topically

What area

Consent, Release of Liability, Waiver of Claims, Assumption of Risks and Imdemnity Agreement(Required)

I, agree and understand that my child, named on this form, a minor pursuant to the Age of Majority and Accountability Act, has my permission to participate in the program/activity or series of programs/activities indicated on this form. As the Parent or Legal Guardian of the child registered in the program/activity or series of programs/activities, I and my child agree to indemnify and hold harmless Winning Circle and staff from all claims, demands, actions and causes of action, loss, costs or damages that Winning Circle and staff may suffer, incur or be liable for in relation to any injury my child may suffer or cause to others in connection with my child’s negligence or actions while my child is participating in the program/activity or series of programs/activities. Furthermore, I and my child hereby release, waive and discharge Winning Circle and staff from all liability to our heirs, executors, administrators for all loss of damage and any claim or demands for such loss or damage due to injury to person or property.

By signing this agreement, I and my child understand that my child will be assuming injury and certain legal risks. I, as the Parent or Legal Guardian of the child, confirm that I understand and agree to the conditions contained in this Agreement prior to signing it.

Furthermore, I confirm that I have received the Conditions of Enrolment and I agree to abide by the terms and conditions outlined therein,

In registering and permitting my child to attend Winning Circle Martial Arts After School Program, I the undersigned parent, guardian or other duly authorized party hereby agree as follows:
• To permit my child to participate in the full range of activities.
• Let my child go to pre-arranged supervised activities outside the Winning Circle Martial Arts facility.
• I understand that photographs and/or video may be used as promotional materials.

I Agree

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Day Camp Enrollment

Day Camp Enrollment

Child Information

Parent(s)/Guardian(s) Information

Health Information

Medication

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