This is the Registration page for our Philosophy Groups, which run during the school year. If you are looking to Register for Eurekamp, our Summer camp program, please proceed here

STUDENT'S PERSONAL DETAILS

First Name:
Middle Name:
Last Name:
Birthday:
YYYY-MM-DD
- -
Gender: female male
Grade Entering September 2016:  
School attending in September 2016:
STUDENT'S CONTACT INFORMATION

Address 1:
Address 2:
City:
Province:
Country:
Postal Code:  
Home Phone:  )  - 
Which Philosophy Group program would you like to register for:

ADDITIONAL INFORMATION

Please share any important medical information, allergies, special interest and requests, so that we can provide the best philosphpy group experience possible for your child:

How did you hear about our Philosophy Groups:

INFORMED CONSENT


Disclaimer Clause

I understand that the University of Alberta and its officers, directors, employees, instructors, and volunteers are not responsible for any injury, loss or damage of any kind sustained by participants during the program or after the program day has ended, except to the extent that such injury, loss or damage was caused by the sole negligence of the University of Alberta staf or volunteers.

Assumption of Risks

In consideration of my child’s participation in the above noted program and all related activities, I and my child acknowledge that we are aware of, appreciate and accept the inherent physical risks and the other possible RISKS, DANGERS, AND HAZARDS associated with being a participant, including the possible risk of severe or fatal injury to my child or others. These risks include but are not limited to:

  1. all manner of injuries resulting from the mechanical failure of apparatus/equipment;
  2. transmission of diseases in various ways and types from contact with other participants resulting in death, disease or other illnesses;
  3. all manner of injuries and/or death that may result from transition between facilities.

Acknowledgement of Responsibility

The parent/guardian and the participant understand and acknowledge the following:

  1. TO FOLLOW all the instructions and rules given by those responsible for or in charge of the above noted program and all related activities while my child is a participant and participating in the above noted program. I understand and accept that the instructions and rules are in place to provide a safe environment for the entire program; and
  2. TO OBEY all the rules and regulations pertaining to the above noted program and all related activities.

Condition of Registration

The parent/guardian and the participant understand and acknowledge the following:

  1. that the participant sees a licensed medical practitioner on a regular basis and to the best of my/our knowledge is physically and mentally able to participate in all activities of this program.
  2. that the participant will wear full protective equipment demanded by the activities or experiment; and
  3. should the participant be injured during the program I/we give permission for University of Alberta staff and volunteers to provide emergency medical treatment.

Sign-out & Emergency Contacts
In addition to myself, I give permission for my child to be signed out by any of the following people or for them to be contacted in the event of an emergency should I not be available, as indicated in the following table:

Permission for Others:

Full Name Relationship to Student Daytime Phone Number Sign-out Emergency Contact
 )  - 
 )  - 
 )  - 

Optional Permissions
I give Eurekamp! and their partners permission to take photos or videos (digital or otherwise) of my child and to reproduce the likeness of my child (no names to be used) in promotional materials, including brochures and audio-visual productions.
I give permission for representatives from Philosohpy for Children Alberta to contact me in the future about Eurekamp events, Philosophy for Children initiatives, or other opportunities related to the program.

I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THIS AGREEMENT, and that I understand, appreciate and accept the risks associated with my child’s participation in the above noted program and all related activities at the University of Alberta or on any pre-determined feld trips. As the parent/guardian for the participant, I consent for my child’s participation in the above noted program and all related activities. My completion of the following fields and continuing with the registration process confirms this.

Registration Completed By:
Your Relationship to Child:
Your Home Phone:  )  - 
Your Emergency Phone:  )  - 
Your Email:

     

Participant/Parent/Guardian: The information requested on this form is collected under the authority of section 33© of the Alberta Freedom of Information and Protection of Privacy Act for the purpose of administering summer camps offered by Philosophy for Children Alberta under the Faculty of Arts and the University of Alberta. Questions concerning this collection, use or disposal of this information should be directed to: EUREKAMP, phone: 780-492-3307 and choose option 4, email: eurekamp@ualberta.ca, fax: 780-492-9160.