Program Registration

Order Number
#
Your order number can be found your Eventbrite ticket.
  • Can't find it? Check your inbox for a confirmation email.
  • Haven't paid yet? Start the process at the A Rocha Ontario page.

General Information





Program
Which program are you registering this child into? (If applicable, please refer to your Eventbrite ticket to ensure that you choose the correct program options.)






Medical Information




If your child has any health concerns (social, emotional, physical, medical, behavioural, developmental, or otherwise) please explain. If your child requires additional support, please provide information on the support person that will be attending.

If your child has any allergies or dietary restrictions, please list them here.

Please let us know if your child carries an epipen.
Media Consent
I hereby grant A Rocha Canada (ARC) the absolute right and permission to use, re-use and distribute, without financial consideration, photographs, video and/or audio of my child (named above) in any and all media, in perpetuity. I also consent to the use by ARC of my child's (named above) personal story for use in any media.

To help us understand the success of our programs, as well as the growth and transformation of our program participants, A Rocha will be gathering participant stories through voice recordings at relevant sharing times (eg. opening and closing circles).

Program participants will be made aware when they are being recorded. These recordings and stories are for internal use only (for gathering data) and will not be publicized in any way, unless Media Consent has been approved above.

The safety and privacy of our participants is vital. If you have questions or concerns, please send us an email at cedar.haven@arocha.ca.

This will act as an electronic signature, confirming
that you have read and agree to the terms above.

Liability Waiver
This program encourages "hands-on" education. While every program activity is appropriately designed for each age group, and carefully taught and supervised by our staff, there are risks involved. A Rocha Canada and Staff will not be held liable for any injury sustained during program activities.

By submitting your name below, you as the parent or legal guardian of the child registered, acknowledge the possible risks, dangers and hazards associated with participation in the activities, and allow for your child to participate in all activities related to the program.

This will act as an electronic signature, confirming
that you have read and agree to the terms above.

Registering another child?
If you are registering more than one child, they must share the same Family Information below. Additionally, all students registered on this form must be paid for together.

Primary Parent/Guardian




This email will receive all program communication
and important announcements.

Second Parent/Guardian or Emergency Contact
In case of emergency, where the Primary Parent/Guardian cannot be reached, this person will be contacted.




This email will receive all program communication
and important announcements.
Carpooling?
Please list the names (First and Last) of any adults not mentioned above who have permission to sign out and assume responsibility of your child(ren) after the program.
Confirmation
By submitting your name (first and last) below you, as the parent or legal guardian of the child(ren) being registered, confirm that the information above is accurate.
This will act as an electronic signature, confirming
that you have read and agree to the terms above.

Contact Information