Health Information & Permission Form

This comprehensive form helps us get to know your child better and covers everything we need to provide the best care and create amazing memories together.

Please take your time filling this out thoughtfully – we know you want what's best for your child, and having all of this information helps us support them in the way that works best for them. Every detail you share helps us create a caring, safe environment where your child can truly enjoy exploring nature with us.

Thank you for trusting us with your child's care. We're here to support both you and your child every step of the way!

EXPLORATION TRIP AUTHORIZATION

I give the Nature and Community Exploration Club Inc and its representatives permission to take my child on short exploration trips and other outings as part of their time in program. This includes transportation by bus, vehicle, on foot or public transportation. Note: Proper drivers licensing and insurance is kept in good standing and the use of approved booster/child restraint seat will be used whenever applicable. If you require a special safety seat please provide one that will be kept on site for the duration of their time in our program. As we are a mobile program, we strive to be as communicative as possible about the daily destination plans, location changes and times. It is extremely helpful if you also communicate your intended pick-up time and location, particularly if it varies day to day.

EVENT WAIVER

Participant Name(s)

Parent/Guardian Name

Today's Date

YYYY

Parent/Guardian Signature

*In all programs offered by Nature & Community Exploration Club Inc, reasonable care is taken to prevent serious injuries and to minimize accidents. I am aware that all activities, even under the safest of conditions, have inherent dangers. I hereby accept responsibility for, and assume the risk of, injury or damage to my child that might arise as a result of participation in Nature & Community Exploration Club. I hereby release, discharge, and hold faultless from any liability whatsoever, Nature & Community Exploration Club, as well as all employees and/or volunteers in their capacity as representatives of said organization. In the event of illness or injury, consent is hereby given to provide emergency medical care, hospitalization, or other treatment, as necessary. I agree to hold Nature & Community Exploration Club faultless if full disclosure or a pre- existing condition has not been provided.

HEALTH INFORMATION

Personal Health Number (PHN):

Allergies

Medications

Any behavioral challenges that may require extra support? The more we know about your child's unique needs, the better we can support them in having a positive experience. Please be as honest as possible – there's no judgment here, only our commitment to helping your child thrive.

It is the policy of this centre to notify a parent when a child is ill or needs medical attention. In the event we cannot contact you and your child needs immediate help, we require signed consent to do so. Check both options if you agree, and sign below:

I give consent for my child to be taken to the nearest emergency medical centre when I cannot be contacted.

I give consent for my child to receive medical treatment.

General Release of Liability I affirm that the confidential health and medical information that has been provided is accurate and complete. I understand that failure to disclose all information could affect my child’s wellbeing and safety, and I agree to hold the Nature and Community Exploration Club Inc. and its representatives faultless if full disclosure or a pre-existing condition has not been provided. In the event of illness, medical emergency or injury, consent is hereby given to provide emergency first aid, hospitalization or other treatment as deemed necessary. I understand that at all times diligence will be taken to prevent serious injuries and to minimize accidents. However, I am aware that all activities, even under the safest conditions can have inherent dangers. I hereby accept responsibility for, and assume the risk of, injury or damage to my child(ren) and their belongings, that may arise as a result of participation of indoor and outdoor play. I hereby release, discharge and hold faultless from any liability whatsoever, Nature and Community Exploration Club Inc, as well as all employees and volunteers in their capacity as a representative of said organization.

Parent/Guardian Name

Parent/Guardian Signature

Today's Date

YYYY

PHOTO & VIDEO PERMISSIONS

I give permission for the Nature and Community Exploration Club Inc. and its representatives to photograph and take videos my child for the following purposes: Type of Use (Please check each one):

Shared on Club’s Instagram

Shared within your Child’s Program on Lillio

Displayed on Business Website

Post on Club’s Facebook Page

Use in Newsletters, Emails, or Marketing purposes

Sent to you using WhatsApp Business

Sent to you using Lillio

I understand that NaCEC will be taking video and/or photographs of it’s program attendees and even in the case of declining, it is my responsibility to update this form in the event that I wish to change permissions on one or more of the above uses. I agree that this form will remain in effect during the term of my child’s enrolment.

Date

YYYY