Codiac LTSS Summer Camp Registration 2019 - Enrigistration Au Camp D’été Codiac IPV En Patin De Vitesse 2019 - Codiac Cyclones

Location: AJL Arena, Dieppe NB
LTSS Dates: July 22 to 25, 2019 (4 half days) / 10:30am – 1:15pm
LTSS Cost: $279 ($239 Early Bird Full Payment Offer until May 10, 2019)
** See Summer Camp FAQ for payment terms and camp application rules.
** $239 LTSS Early bird full payment offer ends MAY 10, 2019
** $279 LTSS camp fee starts May 11, 2019

Looking for another Summer Camp Program?

High Performance (HP) Speed Skating Registration (Click Here)

Step 1 of 6 - SKATER INFORMATION

There are currently 24 Learn to Speed Skate (LTSS) spots left in this block of registrations.
(Subject to change without notice)
Skater's Name*
Note: If you are a short track speed skating coach registering for the Camp Mentoring Program must enter your name here.
First Last
Email*
Enter Email Confirm Email
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Age as of June 30, 2019*
Please enter a number from 6 to 11.
Club*
2018-2019 Season / saison 2018-2019
SSC Number / No. PVC*

Summer Camp 2018
LTSS T-Shirt
One per registrant
(No Additional Charge)
T-Shirt Size*
NO T-SHIRT AFTER JUNE15 REGISTRATIONS*
ONLY CAMP ACTIVITIES ARE INCLUDED IN YOUR FEES AFTER JUNE 15, 2019. T-SHIRT and GIFT BAG ARE NOT INCLUDED IN YOUR FEES DUE TO REQUIRED LEAD TIMES AND POST JUNE REGISTRATION REQUIREMENTS.
Billeting for Skaters
One per registrant
The Codiac Cyclones will attempt to facilitate billeting opportunities by putting interested out-of-town skaters in contact with local families willing to host. We can not guarantee that requests will be met by an offer because this is dependent on volunteerism. Please consider $175 per week per skater as a financial contribution paid directly to the host family.
Billeting Requested?*
Billeting NOT Offered / demande d'hébergement en famille non disponible*
Billeting requests are not available for post June 15 registrations. / Les demanded d'hébergement en famille ne sont pas disponibles après le 15 juin.

EMERGENCY CONTACT INFORMATION
Parents/guardians of skaters enrolled in the camp must be available, or be able to make equivalent arrangements on short notice, in case of emergency. Please provide a phone number where someone can be reached in case of emergency, day or night. In addition, for medical and insurance purposes, the Personal Health Section must be completed with this Registration Form.
Parent/Guardian Name:*
First Last
Cell Phone:*
Other Phone:
Volunteer Parent(s)?*
There will be various activities during the week that will require volunteers. Are you available to help out the summer camp organizers during the week?
Great!*
What would you like to help us out with?
Alternate Parent / Guardian Name:
First Last
Cell Phone:
Other Phone:

PERSONAL HEALTH INFORMATION
The information in this section will be used at the discretion of the coaches and camp personnel to ensure care and attention is given to the health and safety of the participant. All information on this form is considered Personal and Confidential.
Height*
Weight*
Provincial Health Ins. No*
Expiry Date:*
Other Health Ins. No
Subscriber’s Name
Family Doctor*
Family Doctor's Phone*
Allergies*
Does the participant have allergic reactions to such things as drugs, food, insect stings, etc.? If so, list, giving type of reaction, treatment given, etc.
Type of Allergies:*
Please describe the type(s) of Allergies.
EpiPen® (epinephrine)*
Does the participating require an epi pen?
EpiPen® Carry*
Is the participating skater prepared to carry the EpiPen® with them at all times?
Does the Participating Skater have any Health Condition(s)?*
Other Conditions:*
Is the participating skater currently subject to any of the following?
- Respiratory Illness
- Seizures
- Motion Sickness
- Ear Infections
- Headaches
- Heart Condition
- High Blood Pressure
- Other
Other Condition Not Listed*
Please describe the type(s) of condition(s) not listed
Health Details*
Chronic conditions or recent illnesses of which staff should be aware.
Instructions*
Please give details of usual treatment should above allergies or condition(s) occur:
Medication Taken?*
Medication(s)*
Please specify details of medication (over-the- counter and/or prescribed) or treatment required.

Are contact lenses worn?*
Special Instructions*
Do you have any other instructions for staff regarding the applicant’s health care and/or diet?
Please give us your details of instructions for staff regarding the applicant’s health care and/or diet.*
Pain Relief / Nausea Relief
Do you give permission for camp personnel to give Tylenol (acetaminophen), Gravol (dimenhydrinate), or Advil (ibuprofen) if needed?
MEDICAL AUTHORIZATION*
I hereby authorize the camp personnel to secure such medical advice and services as may be deemed necessary for the health and safety of the participating skater.

Payment Options:*
LTSS CAMP FEE
Option LTSS-A1: (ACTIVE) $249.00 (Post June 15, 2019 Full Payment At Registration Only) Offer ENDS July 15, 2019 - NOTE: THIS LTSS-A1 OPTION IS ONLY OFFERED AFTER JUNE 15 AND DOES NOT INCLUDE ANY T-SHIRT OR GIFT BAG DUE TO THE REQUIRED PRODUCTION LEAD TIME. IT ONLY INCLUDES THE 4 HALF DAYS OF LTSS CAMP.
(EXPIRED) - Full Payment $249 or $100 deposit and $179 balance payment payable before June 15, 2019 ($279 total). Deposits are nonrefundable 5 business days after payment. You will lose your deposit and your reserved spot should the balance owing of $179 not be paid in full prior to June 15, 2019.
Option S1: (EXPIRED) $249.00 (Full Payment At Registration Only)
Option S2: (EXPIRED) $279.00 ($100.00 Deposit Now + $179.00 Balance Before June 15, 2019)

FAMILIES
There are no family rates for the LTSS program.
CAMP AGREEMENT
The skater covered under this registration and their respective parent/guardian signing this Registration Form, hereby agree that the Codiac Cyclones Speed Skating Club and/or Nagano Skating Academy, and all authorized personnel (coaches, supervisors, etc.) may create guidelines from time to time for the safe and responsible operation of the Camp. The undersigned skater and parent/guardian agree to abide by the guidelines and acknowledge that failure to comply with the guidelines may result in expulsion from the Camp.

WAIVER
In consideration of accepting this application, I hereby, for myself, my heirs, executors, administrators and assigns, waive and release any rights and claims for damages I may have against SSC, SSNB, The Codiac Cyclones Speed Skating Club, Nagano Skate, the AJL Arena, the City of Dieppe, City of Moncton, City of Riverview, and its agents, officers, or members for all and any injuries suffered by me at the Summer Camp to be held at the AJL Arena in Dieppe, NB, Monday July 22 to Friday July 26 2019.
Cancelation & Refund Policy
LTSS payments are non-refundable five (5) business days after registration. However, those who pay the full LTSS camp amount upon registration can qualify for a partial refund (i.e. full amount paid less the regular $100 deposit amount) upon reception of a writing request via email sent to the camp administrator until May 31, 2019. Refund for Medical or Accidental Reasons - No refunds due to medical or accident related reasons will be authorized after May 31, 2019 unless the camp is oversold and that there is a registration waiting list with an alternate skater avilable to replace the vacant spot. Any request for cancelation/refund received prior to May 31, 2019 , will be considered on an individual basis by the Codiac Summer Camp director. Cancelations due to medical reasons prior to May 31, 2019 must be accompanied by a doctor’s note stating the medical reason why the skater cannot attend the camp at the time of request at which point a partial refund (i.e. full amount paid less the regular $100 deposit amount) will be issued. When applicable, the deposits component of a full registration payment (i.e. $100 component of your full payment) is non-refundable five (5) business days after registration. Some with additional health/medical insurance coverage might qualify for a partial or full summer camp refund due to medical/accidental reasons.
Do you accept the Camp Agreement and Waiver?*
- Yes I accept
Today's Total
$ 0.00 CAD
SIGNATURE OF SKATER OR, IF SKATER UNDER 18, PARENT/ GUARDIAN:*
You can sign online by typing your full name starting with a forward slash and ending with a back slash.
Example: /John Doe\
Date*
Date Format: MM slash DD slash YYYY
CAPTCHA

Share This:

Step 1 of 6 - SKATER INFORMATION

There are currently 24 Learn to Speed Skate (LTSS) spots left in this block of registrations.

Summer Camp 2018LTSS T-Shirt

Billeting for Skaters

EMERGENCY CONTACT INFORMATION

PERSONAL HEALTH INFORMATION

LTSS CAMP FEE

FAMILIES

CAMP AGREEMENT

WAIVER

Cancelation & Refund Policy

Summer Camp 2018
LTSS T-Shirt