Pivot Point Inclusive Summer Camp Registration Form

Camper Information

Medical Information

Program Information

Camp times - 9:00 AM to 4:00 PM, drop off starts at 8:00 AM and pick-up ends at 5:00 PM. (*Late pick-up fees will apply*)

Payment Information

$600.00 per child/week

Payment must be made upon receipt of the invoice. Payment can be made via e-transfer or credit card. Once your registration form is submitted, an invoice will be sent to the "Parent/ Guardian 1" listed under the Camper Information section.

Refund Policy

Please read the Refund Policy available on the Summer Camp page.

Consent and Agreements

Liability Waiver

Please note that Country Heritage Park is a working farm and historic site; therefore,

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.

Risk inherent in an agritourism site:

(a)  the surface and subsurface conditions of land,

(b)  the behaviour or actions of wild animals not kept by or under the control of an agritourism provider,

(c)  the behaviour or actions of domestic animals other than a dog in respect of which an order has been made under subsection 4 (3) of the Dog Owners’ Liability Act before the day the agritourism activity is engaged in,

(d)  the ordinary dangers associated with structures or equipment ordinarily used in farming operations,

(e)  the possibility of contracting illness resulting from physical contact with animals, animal feed, animal waste or surfaces contaminated by animal waste, and

(f)  the possibility that a participant may act in a negligent manner, including by failing to follow instructions given by the agritourism provider or by failing to exercise reasonable caution while engaging in the agritourism activity that may contribute to injury to that participant or another participant. (“risque inhérent à une activité agrotouristique”)

Photo Consent Release

By signing this consent form, I give Country Heritage Park permission to take photographs and videos of my child during Day Camp programing. I understand that these photos may include my child's face and may be used for promotional purposes on social media and other platforms. 

I acknowledge that counselors are responsible for notifying marketing staff in advance if any campers do not wish to be photographed, and an opt-out list will be provided to the counselors. If I prefer that my child’s likeness not be used, I will inform the staff accordingly.

Code of Conduct and Behaviour Guidelines

Camper Code of Conduct

Country Heritage Park (CHP) Camp Staff use a positive, values-based approach to guide appropriate behaviours and to encourage and reinforce positive behaviours. Children are expected to follow CHP Day Camp behaviour expectations and to interact appropriately with their fellow peers, staff, and volunteers.

Our goal is for each child to have a positive and memorable experience. In order to achieve this, the safety of each child is of the utmost importance. Parent/guardian(s) and children must recognize a personal responsibility to learn and follow safety and other rules established by Country Heritage Park.

Behaviour Guidelines

All campers must:

• Be responsible for their actions, choices and words;

• Be respectful to each other and their environment;

• Be honest and true to their word;

• Care for themselves and those around them;

• Make healthy and safe choices; and

• Value diversity and seek to include others.

All children are expected to follow the CHP behaviour guidelines, and to interact in a positive and appropriate manner with their fellow peers, staff, and other members of the CHP Camp community. Behaviour (including but not limited to: violence, swearing, harassment; verbal threats; physical behaviour; running away; destructive behaviour etc.) that negatively impacts others physically or emotionally may result in dismissal or permanent removal from camp at the discretion of Country Heritage Park. Children may also be removed from camp as a result of behaviour that places themselves or others at risk.

Refunds will not be granted for dismissal prior to the end of the camp day or week.

Acknowledgment

1. Review of Camp Participation Waiver: I have had full opportunity to review the Waiver and fully understand the terms of the Waiver and the fact that I am waiving certain legal rights which my child or their heirs, next of kin, executors, administrators, assigns and representatives may have against the Country Heritage Agricultural Society (Country Heritage Park).

2. Opportunity to Obtain Independent Legal Advice: I have had full opportunity to obtain independent legal advice relating to the Waiver.

3. No Pressure or Influence: I am granting this Waiver freely and voluntarily and as my own act without any pressure or influence from or by any person.

4. Reliance: The Country Heritage Agricultural Society (Country Heritage Park) is relying on this Acknowledgment and Waiver in entering into this Agreement.

5. I understand as a parent/guardian of a child who is a participant in Camp at Country Heritage Agricultural Society, also known as Country Heritage Park ("Country Heritage Park"), my child will participate in activities including but not limited to physical activities, group games and learning activities on the grounds of Country Heritage Park.

6.  I certify that the information provided in this registration form is, to my knowledge, true and complete.

7.  I confirm that I have the complete custody, care and control of the minor and have the legal authority.

Pivot Point will be in touch to arrange a meeting to complete a risk assessment.