Informed Consent and Emergency/Medical Form

Please Note: Please complete this form for each child attending day camp once per calendar year.

Please note a separate form is required for each child.

**Contact and Medical Information**

The personal information is collected to be used in the event of a medical emergency in the Regional Field House program(s).

Does your child have any allergies?

Does your child take any medication?

Does your child require an aide at school?

Please Note: If your child requires an aide at school, they will require an aide for day camp related activities.

Informed Consent: I authorize my child to participate in the Nustadia Recreation Inc. Daycamp program, which I understand may involve, but is not limited to the following activities: walking to and from parks and other facilities, indoor/outdoor games and activities, playing on playground equipment, and swimming. I am aware and acknowledge that certain risks of injury are inherent to participation in sports and recreational activities. These types of injuries may be minor or serious and may result from one's actions, or the actions or inactions of others, or a combination of both. Nustadia Recreation Inc. contracts a commercial bus transportation service for all in-town of out-of-town field trips when scheduled. Nustadia Recreation Inc. may secure such medical advice and services as it, in its sole discretion, may deem necessary for the participant's health and safety and I shall be financially responsible for such advice and services. I declare that I have read, understood and agree to the contents of the Daycamp Informed Consent Form in its entirety.*

Photo Consent: I hereby consent to the use of and grant to the Nustadia Recreation Inc. the right to use, for the purposes of promoting the recreational programs or services, any photographs taken of the minor specified above while they attend the daycamp program may be used for future publications & promotions. I grant such consent as parent and/or guardian to the above minor pursuant to Section 17(2)(a) of the Freedom of Information and Protection of Privacy Act. I understand no other personal information about the minor will be released by the Nustadia Recreation Inc. without my permission.

The personal information on this form is collected under the authority of section 33(c) of the Freedom of Information and Protection of Privacy Act (FOIP) to be used in the administration of Nustadia Recreation Inc. Camps and in the event of a medical emergency and will be provided exclusively to qualified personnel. If you have any questions regarding the collection of this information please contact Darial Poxon, Programs & Special Event Director for Nustadia Recreation Inc, 587-757-0338 ext 305

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Hours of Operation

Administration Office Hours

Monday - Friday
8:00am - 4:30pm

Crescent Point Regional
Field House

125 Fieldhouse Drive East
Okotoks, Alberta T1S 0C4
Phone: 587.757.0338

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