2021 Arts Summer Day Camp Registration Youth InfoHow many youth are you registering?*OneTwoYouth #1 - Name* First Last Youth #1 - Gender*FemaleMaleYouth #1 - Date of Birth* DD MM YYYY Youth #1 - Age as of Aug. 16, 2021 (ages 9-13)*Please enter a number from 9 to 13.Youth #1 - Allergies or medical conditions?Youth #2 - Name First Last Youth #2 - GenderFemaleMaleYouth #2 - Date of Birth DD MM YYYY Youth #2 - Age as of Aug. 16, 2021 (ages 9-13)Please enter a number from 9 to 13.Youth #2 - Allergies or medical conditions?Guardian & Home InfoParent/Guardian #1 - Name* First Last Parent/Guardian #1 - Email* Parent/Guardian #1 - Cell Phone*Parent/Guardian #2 - Name First Last Parent/Guardian #2 - Email Parent/Guardian #2 - Cell PhoneHome Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Home Phone (if not a cell phone)ConsentsPARTICIPATION/MEDICAL: I give permission for the youth in my care noted above, to attend and participate in this program set forth by Northumberland Youth Unlimited (YFC) and/or Northumberland Promise. I also give permission for the person(s) in charge to seek medical assistance for the youth in my care noted above in the event of accident or injury.** Yes, I give permission. No PERSONAL HARM: Furthermore, I agree to not hold Northumberland Youth Unlimited (YFC) and/or Northumberland Promise or any of its subsidiary programs, staff, volunteers, directors or officers responsible for any harm that may occur to the youth in my care noted above as a result of his/her wilful participation in the event.** Yes, I agree. No AGE 10+ PERMISSION TO SIGN IN/OUT: I give permission for the youth in my care noted above (age 10+), to sign him/herself in and out without a parent present. In doing so, I release Northumberland Youth Unlimited (YFC) and/or Northumberland Promise of any responsibility after he/she signs out and leaves the building.* Yes, I give permission. No PHOTO/VIDEO: I do authorize Northumberland Youth Unlimited (YFC) and/or Northumberland Promise to take, use and own, in perpetuity; names, photographs or video/audio recordings of the youth in my care noted above, understanding that these may be used for public promotional purpose. Northumberland Youth Unlimted and Northumberland Promise do not sell or give away any recorded materials or personal information.** Yes, I authorize. No PaymentArts Camp Spots* Price: $ 90.00 CAD Quantity: Total $ 0.00 CAD Payment Method*Credit Card (via PayPal)E-TransferIMPORTANT: Thank you for paying via e-transfer! After you click Submit below, you will receive an email with payment instructions.IMPORTANT: Thank you for paying via Credit Card! Once you click Submit below, you will be redirected to PayPal to complete your registration payment. You do not need a PayPal account (see image below).SIGNATURE: I acknowledge that clicking on the SUBMIT button below serves as my legal signature.* Yes, I acknowledge. No NameThis field is for validation purposes and should be left unchanged.