Camp Volunteer Information & Waiver Form

First Name

Last Name

Phone Number:

Email Address

Health Card Number (No spaces):

Date of Birth (mm/dd/yyyy):

Shirt Size (select one):

Small

Medium

Large

Extra-Large

Schools or school representatives (e.g. teachers, guidance counsellors) will sometimes reach out directly to the Town of Aurora to verify submitted community service hours.

Do you give Town staff permission to provide this information to schools if the Town of Aurora is contacted?

Yes

No

Parent/Guardian Contact Information

Parent/Guardian Name #1:

Parent/Guardian #1 Daytime Phone Number:

Parent/Guardian #1 Cell Phone Number:

Parent/Guardian Name #2:

Parent/Guardian #2 Daytime Phone Number:

Parent/Guardian #2 Cell Phone Number:

Emergency Contact Information

Emergency Contact Name:

Relationship to Volunteer:

Emergency Contact Daytime Phone Number:

Emergency Contact Cell Phone Number:

Volunteer Medical Information

Are there any physical concerns that we should be aware of that will limit full participation in the program?

Yes

No

Do you have allergies?

Yes

No

Do you require an EpiPen/Auto Injector for allergic reactions?

Yes

No

Are you currently taking any medications?

Yes

No

Do you have any special needs? (Medical, Physical, Emotional, Behavioural, Social)

Yes

No

Volunteer Dismissal Information

Based on their age, volunteers are permitted to leave at the end of the camp day without parent/guardian signature or consent. Unless previously indicated, volunteers cannot leave camp before the end of the program. Please indicate below how you will be leaving camp at the end of each day.

Select One

Walk Home Alone

Walk Home with a Sibling

Wait Unsupervised at the Camp Location (outside the building) to be Picked Up