KIDSBKIDZRegistration Form"*" indicates required fieldsWelcome to the Vancouver KIDS-B-KIDZ Registration Form Please fill out the following information in order to register your child(ren).Child first and last name* First Last Date of birth* MM slash DD slash YYYY Gender* Male FemaleAddress* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonProvince Postal Code CARE CARD # Healthcare Information (Child )Family Doctor Name*Does your child take regular medication? If yes, please list ALL of your child's regular medications and the reason(s) they are taken.*Does your child have any allergies? If yes, please list ALL allergies and their medications.*Does your child have any special conditions, injuries or illnesses that we should be aware of? If yes, please list them all, AND describe any specific care instructions.*Is your child up to date with his or her immunizations?* Yes NoPlease explainAdditional commentsApplicant Parent's Name*Second Parent's Name*Cell Phone Number*We will text reminders to this numberHome Phone NumberEmail Activity & Field Trip Consent*I, the Parent/Guardian, consent for my child(ren) to participate in all activities within the AICP Summer program, including field trips, outdoor walks, and arts & crafts.Registration can be completed for the full duration of the Program (two months). It can also be done 1 month, or 1 week at a time. You can always add extra time to your child(ren)'s registration.Season one runs from July 4 until July 28. Season two runs from July 31 to August 25. July 4th to 7th July 10th to 14th July 17th to 21st July 24th to 28th July 31st to Aug 4th Aug 7th to Aug 11th Aug 14th to Aug 18th Aug 21st to Aug 25thPick-Up Permission Please enter the information of the person(s) authorized to pick up your child(ren), other than the parent/guardian listed above. If no one other than the parent/guardian has pick-up permission, please leave these fields blank.PERSON #1* First Last Phone*Relationship to Student*PERSON #2 First Last PhoneRelationship to StudentPERSON #3 First Last PhoneRelationship to StudentEmergency Contact The emergency contact is the person we would call in the event of an emergency, if the parent/guardian does not respond. This CANNOT be the same person as the parent/guardian.Full Name* First Last Phone*Relationship to Student*Important Information Please have your child bring: - an extra set of clothes (pants, shirt, undergarments, socks), labeled with your child’s full name. - lunch everyday (one meal and two snacks) - two water bottles everyday - sneakers - sunscreenIf more than one of your children is attending the Program, ensure that each child has their own lunch. Also please remember to have your child(ren) dress for the weather.Please note that AICP is not responsible for any damaged or stolen goods.AgreementExcept an event of misconduct or negligence by AICP staff, I hereby not hold AICP, its board, or its employees responsible for any medical or personal injury to my children within the program, or any other loss or damage, and hereby waive any claim against AICP. I acknowledge that it is my responsibility to take the necessary steps for insuring against personal injury, loss, property damage, or any other loss of damage that might be incurred at the property during the term of this agreement.Confirmation of InformationI confirm that the information I have provided in this registration form is correct to the best of my knowledge.Date* MM slash DD slash YYYY Applicant Parent Initials Here*
