April Break 2021 Application Form -Please read carefully all terms and program requirements listed below-You are about to complete an application form for Camp Awakening @ Home for April Break. The program takes place April 12-16, 2021.Please fill out this form and return by Wednesday, March 31, 2021 @ 5 pm. *We will accept applications after this deadline, but please note that shipping of your ‘camp-in-a-box’ care package may be significantly delayed. April Break Application Form PART 1: Participant Information Camper Name * Camper Age as of April 1, 2021 * Camper Email Address Parent/Guardian Email Address for all communications * Mailing Address (this is where your camper's April Break package will be sent): Street * City * Province * Postal Code * PART 2: Program Logistics and Cost Camp Awakening @ Home for April Break is a brand new program, consisting of a combination of virtual games & gatherings and a mailed care package, full of independent activities & resources. For this program, we are simply asking you to “contribute-what-you-can”. Camp Awakening is a small charity and we have experienced significant financial loss due to the pandemic. Any amount, small or big, to help offset the cost of shipping & materials is so appreciated It’s been a tough year, so please know that we will not be turning away anyone who is eligible and interested in participating. PART 3: Terms of Participation - To Be Read and Signed By Camper Campers are expected to behave in a way that enables themselves, their fellow campers, and Camp Awakening staff and volunteers to have a safe, positive, and enjoyable Camp Awakening @ Home for April Break experience. By signing these Terms of Participation below, I agree to: Actively participate in the Camp Awakening @ Home for April Break program Treat others, including my supervising parent/guardian, fellow campers, Camp Awakening staff and volunteers with respect. Take a minimum of 2 photographs of myself completing activities and email them to info@campawakening.com Provide feedback on this brand new program- Share with us what you like and what you did not enjoy! Electronic Signature of Camper * Date DD/MM/YYYY PART 4: Photo and Video Consent - To Be Read and Signed By Parent/Guardian By signing below, I agree to allow Camp Awakening to use photographs and/or video footage taken of my child while involved in Camp Awakening @ Home for April Break activities to be used for the purposes of fundraising, advertising & promotion, information sharing and for any purpose consistent with Camp Awakening’s mission. In our online/virtual programming, we may capture your child’s name, photo, voice or likeness in a digital or recorded form. I understand that I will not have an opportunity to review or approve uses of the recordings. I Agree I Don't Agree PART 5: Assumption of Risk - To Be Read and Signed By Parent/Guardian I understand that my child’s participation is voluntary and that as a condition of my child’s participation, I agree to all terms of participation and program requirements in this document. I understand that I, as the parent/guardian, retain full supervisory responsibility for any and all Camp Awakening @ Home for April Break activities. I understand that as a new and untested program there are potential risks connected with my child’s participation. I acknowledge that Camp Awakening is not responsible for any injury, illness, cybersecurity breaches, or damage or loss of personal property that occurs as a result of participation in the Camp Awakening @ Home for April Break program. I give permission for personal information about my child, collected by Camp Awakening, to be shared with Camp Awakening @ Home for April Break staff and volunteers. Information will be used solely for programming purposes. I understand that going to public spaces is not a program requirement. If I, or my child, choose to participate in Camp Awakening @ Home for April Break’s activities in a public space, I agree to follow current Public Health guidelines for my region while participating in the activity. I acknowledge that Camp Awakening may engage with third party service providers to provide online resources that will be used as part of the Camp Awakening @ Home for April Break program and that those third party service providers may collect information from you and your child. The third party service providers engaged for Camp Awakening @ Home for April Break are listed below: Zoom YouTube Facebook Instagram Canada Post I acknowledge that any additional questions or concerns have been communicated to a Camp Awakening staff member in writing. Electronic Signature of Parent or Guardian * Date DD/MM/YYYY reCAPTCHA Submit