Registration Form

Contact #1

Name

First Last

Relationship to Camper

Mother, Father, Grandparent, etc.

Home Phone

Business Phone

Cell Phone

Address

Street Address Address Line 2 City Province Postal Code

Contact #2

Name

First Last

Relationship to Camper

Mother, Father, Grandparent, etc.

Home Phone

Business Phone

Cell Phone

Address

Street Address Address Line 2 City Province Postal Code

Emergency Contact

(Emergency contact if the parent(s)/guardian(s) cannot be reached)

Name

First Last

Preferred Phone #

Relationship to Child

Mother, Father, Grandparent, etc.

Name

First Last

Preferred Phone #

Relationship to Child

Mother, Father, Grandparent, etc.

Annex Children's Theatre in Education, (ACTE), may only release my child into the care of the following individuals:

Hidden

Consents

Digital Signature

Parent/Legal Guardian

Date Signed

ACTE. AGREEMENTS OF RELEASE AND INDEMNITY

I, THE CHILD(REN)’S PARENT/GUARDIAN, FOR MYSELF AND ON BEHALF OF MY CHILD(REN), HAVE READ AND UNDERSTAND THE POLICIES SET IN PLACE BY ACTE AND AGREE TO RELEASE AND FOREVER DISCHARGE (AGREEING TO MAKE NO CLAIM, AND NOT TO SUE) AND INDEMNIFY AND HOLD HARMLESS ACTE, AND THEIR RESPECTIVE OWNER, MEMBERS, DIRECTOR, EMPLOYEES, CONTRACTORS, AGENTS, REPRESENTATIVES, SUB-CONTRACTORS AND VOLUNTEERS (INDIVIDUALLY AND COLLECTIVELY REFERRED TO AS “RELEASED PARTIES”) WITH RESPECT TO ANY AND ALL CLAIMS RELATED TO CONTRACTING THE CORONAVIRUS (COVID-19) OR ANY OTHER ILLNESS AND/OR INJURY AND ANY LOSS, BODILY INJURY, OR DAMAGES ASSOCIATED FROM IT WHICH I, ANY FAMILY MEMBER, OR MY CHILD(REN) MAY SUFFER, ARISING OUT OF OR IN ANY WAY RELATED TO HIM/HER BEING ENROLLED IN ACTE, AND ON OR OFF THE PREMISES USED BY ACTE. THESE AGREEMENTS OF RELEASE AND INDEMNITY INCLUDE CLAIMS CAUSED OR CLAIMED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF A RELEASED PARTY. I UNDERSTAND THAT IN SIGNING THIS AGREEMENT I, FOR MYSELF AND FOR MY CHILD(REN) SURRENDER THE RIGHT TO MAKE A CLAIM OR FILE A LAWSUIT AGAINST A RELEASED PARTY, FOR PERSONAL INJURY AND EVEN DEATH.

Any dispute between ACTE or another Released Party and me or my child(ren) shall be governed by the laws of Ontario. If any part of this agreement is found by a court of competent jurisdiction to be invalid, the remainder of the agreement nevertheless will be in full force and effect. I, the child(ren)’s parent/guardian, have read and accept the terms and conditions of this Agreement, and acknowledge and agree that it shall supersede and replace all other discussions, agreements (whether verbal or written), contracts, representations, promises, negotiations or any other matter. This document can only be changed, modified or amended in writing by both parties. I also agree that this document is effective upon me and my child(ren), and our respective heirs, personal representatives, estates and family members once my child(ren)’s is enrolled in ACTE.

I agree

Payment Method(Required)

Interac E-Transfer

Credit Card (subject to a processing fee)

Upon submitting your application, please submit your fee in full to [email protected]. Please note your registration will not be considered complete until the payment is received.

Please note all payments by credit card are subject to a 3% fee.

Processing Fee (OLD)

Processing Fee

Registration Total

Credit Card(Required)

Card Details

Cardholder Name

Registration Form

Student's Information

Program

Classes

Annex Young Players Tuesdays

Annex Young Players Wednesdays

Annex Young Players Thursdays

Annex Youth Players Tuesdays

Dramatic Play SK – Gr. 3, Mondays

Dramatic Play SK – Gr. 2, Wednesdays

Play Creation

Camp Enrolment

Registration Total

Contact #1

Contact #2

Emergency Contact

Medical Information

Consents