MARCH BREAK CAMP REGISTRATION FORM * March 16th-20th, 2026 Days Offered * Full Days: 9-4pm ($240+HST) Half Days M-F: 9-12pm ($115+HST) Half Days M-F: 1-4pm ($115+HST) Parent/ Guardian Name * First Last Address: * Phone Number * Email Address * Child Name * First Last Age (4-7) * — Select — 4 5 6 7 - *Junior Kindergarten school age children only Age (8-11) * — Select — 8 9 10 11 - Gender * — Select — Female Male Child Name 2 First Last Age (4-7) — Select — 4 5 6 7 - *school age children only Age (8-11) — Select — 8 9 10 11 - Gender — Select — Female Male Emergency Contact Name & Phone Number * Doctor's Name and Phone Number * Medical Concerns Does your child have any allergies, medical concerns, or food restrictions that we should be aware of? * — Select — N/A Child 1 - Yes Child 2 - Yes Both Child 1 & 2 - Yes If any please tell me about them here Does your child carry an EpiPen? * — Select — N/A Child 1 - Yes Child 2 - Yes Child 1 & 2 - Yes Anything else you would like to tell us ? Informed consent agreement: Print Your Name and the date * I, the undersigned, hereby agree to indemnify and save harmless Willowjays of Sunderland, their/its, instructors, coaches, employees, members against all claims, demands, damages, actions, suits or proceedings arising out of participation of myself/my child, named above, in any camp activity. • I, the undersigned, hereby acknowledge that certain risk of injury are inherent to participation in physical fitness & camp activities. These types of injuries may be minor or serious and may result from one’s own actions, or the actions of others, or combination of both. • I, hereby warrant that my child is physically fit to participate and understand that the choice to participate brings with it the assumption of those risk and results which are part of these activities. • I agree to allow my child to receive basic first aid/medical care from instructors/coaches certified in first aid if necessary. • Willowjays reserves the right to use photographs of members for promotional purposes. If you do not wish your child’s photograph to be taken, please notify Willowjays in writing. • I declare having read and understand the above informed consent agreement in its entirety and hereby consent to participate acknowledging all the foregoing. I also certify that the information provided in this form is, to my knowledge true and complete. Bill 186, Growing Agritourism Act, 2024: Print your name and date * WARNING: under Ontario law, an agritourism provider is not liable for the death or injury or illness of a participant in an agritourism activity conducted at this agritourism location if that injury or death or illness results from the inherent risks of that agritourism activity. Inherent risks of agritourism activities include, but are not limited to, the risk of injury inherent to land, equipment and animals as well as the potential for you as a participant to act in a negligent manner that may contribute to your injury or death. You are assuming the risk of participating in this agritourism activity. https://www.ola.org/en/legislative-business/bills/parliament-43/session-1/bill-186 PHOTOGRAPHED TERMS * I give consent for my child to be photographed for promotional purposes I do not give permission for my child to be photographed PAYMENT OPTIONS * (PLEASE TYPE YOUR PAYMENT CHOICE ABOVE) PAYMENT IS DUE IN FULL TO SECURE YOUR SPOT. All ETF payments is subject to HST. Send ETF payments to renee@willowjays.ca (please put your child's name in the subject line) FAQS, FEE'S, PROGRAM SCHEDULE * I have read and understand all FAQS, program scheduling and fee's.