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Recreation Division Summer Camp Health and Information Form

The City of Peterborough undertakes to safeguard your child while participating in Recreation Division day camp programs. If you require further information, please contact the Recreation Division at 705-742-7777 ext. 1873.

Completion of this form is mandatory for each child attending camp. For additional children please scroll to the bottom of form and 'Add child'.

Pick-up and alternative emergency contact authorization

Please list any alternative caregivers that are authorized to pick up your child(ren) from camp. NOTE: children will only be released to those individuals listed below, and contacts will be listed as alternative emergency contacts for your child.

Medical information

If Camper requires medication such as prescription medications, puffers, epi-pens, etc., or additional information is required to assist our staff, please complete an Administration of Medication form.

Assistive support

If camper requires 1:1 supervision, please provide the name of the adult that will be attending the program with the child, as well as copy of a current police and vulnerable sector screening.


Please read carefully

• I permit my/our child to participate in all program activites, including supervised offsite trips and activities if required of camp program;

• I understand the nature of these activities and certify that the information in this document is true and correct, and agree to disclose any and all information which would prevent or limit the participant from full participation or success within the program;

• I agree to permit camp staff to act on my behalf in case of emergency;

• I confirm that I understand and will abide by the conditions of registration, and the policies and procedures of the City of Peterborough Recreation Division;

• I certify that as an individual parent/guardian agreeing to these terms, I am acting as an agent of the other parent(s)/guardian(s) and have the authority to execute this agreement on their behalf.