Registration & Health Information Form OMFS Registration and Health Information Step 1 of 5 20% Child's Name* First Last Any nicknames that your child goes by? Child's Gender Pronouns* Child's Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Parent A's Name* First Last Parent A's Email* Parent A's Primary Phone*Alternate Phone NumberParent B's Name First Last Parent B's Email Parent B's Primary PhoneWhat phone number is best for us to reach you at during the Forest School Day?*Please list the name and phone number of this person. To which email address would you like us to send invoice and newsletter information?* Who does your child primarily live with? If shared custody, please describe this arrangement.* Are there any custody issues that we should be aware of at OMFS? If yes, please indicate details: Emergency Contact's Name*Must be someone other than parents, in case parents cannot be reached. First Last Emergency Contact's relationship to child* Emergency Contact's Phone*Who other than parents or emergency contact may pick up your child from Forest School?*~please input n/a if no one else is applicable. NameRelationship to child Child's Health Card Number* Child's Family Doctor Name and Phone Number* Has your child received a tetanus immunization?*Please indicate date below if applicable Yes No Immunization Date Month Day Year Has your child been stung by a bee/wasp?*Please describe any reaction below Yes No Bee sting reaction?* Please list any allergies below:*If your child does not have allergies, please indicate "n/a" in each section here. If your child requires an epi-pen, you are required to fill out the OMFS Medication Form as well. AllergenReactionEpi-pen required? Are there any foods that your child cannot eat?*During campfire cooking we offer a wide variety of foods. Please let us know if there is a food that your child cannot eat. General Health Information:*Please check all boxes that apply and give necessary details below: (*Note: if your child requires medication for any of these conditions, you are required to fill out the OMFS Medication Form as well) Asthma Dietary Restrictions Activity Restrictions Seizures Visual or Hearing Impairment Diabetes Other None Please describe any of the above health concerns: Please list any items you may supply for us to assist your child in applying:(eg. lip balm, vaseline, sunscreen, insect repellent, etc.) Please check here indicating that you agree to authorize OMFS representatives* Select All I hereby authorize the representatives of OMFS to contact my child’s physician and/or have my child taken to a hospital or health care facility in case of serious illness or an accident involving my child. Parents will also be contacted. I give my permission to the representatives of OMFS to administer required over the counter first aid medications including Children’s Benadryl, Polysporin and Burn ointment I give my permission to the representatives of OMFS to administer ESSENTIAL prescription medication, which I provide, and which must be LABELLED and kept on hand for use by my child. (ie. epipen, asthma inhaler etc. ) If you did not check one of the above, please explain: Signature for Consent to Above Indicated First Aid*Your signature here authorizes OMFS representatives regarding the above checkboxes Information About Your Child:Getting to know each child personally is very important to us at OMFS. The answers you provide to the following questions will give us a starting point to understanding your child’s interests.What does your child enjoy doing, in their free play time?* Please describe your child's academic schooling for this school year:* What interests or fascinates your child?* Does your child have siblings? What are their ages?* How comfortable is your child spending time outside, in all types of weather?* How does your child typically respond when faced with a challenge or a new situation?* Are there any other details that you feel would best help us understand your child and their needs?* Parent/Guardian Responsibility*(Notes: The Parent Handbook has been updated August 2021 - please be certain to review. If you are in need of outdoor gear and are having trouble sourcing this, please be in touch with OMFS) Select All As the parent or guardian of a participant in an OMFS program, I attest to having read and agree to the terms set forth in the OMFS Parent Handbook I agree to sending the Participant to the OMFS program with adequate and appropriate outdoor clothing and footwear, based on the weather conditions for the day and season and have referred to the OMFS Parent Handbook section on "How to Dress for Forest School" I agree to the firm drop off and pick up times noted in the OMFS Parent Handbook I agree to the 2021/22 Covid-19 related policies indicated on the Parent Portal Parent/Guardian Responsibility Signature* Photo Consent - PLEASE ONLY CHOOSE 1 FIELD*OMFS may wish to take photographs of the participant while participating in Forest School programming for the purpose of promoting the business of OMFS or for educational or parent communication purposes. Please indicate below as to whether you consent or do not consent to OMFS taking and using such photographs and/or videos of your child. YES. I consent to OMFS taking photos and videos of my child and using them in promotional materials and/or for educational or parent communication purposes (ie. Seesaw) YES. I consent to OMFS taking photos and videos of my child but DO NOT wish such photos and videos to be used in promotional materials and/or for educational purposes. Photos and/or videos may still be shared in our communication app - Seesaw NO. I do not give OMFS consent to take photos of my child. By selecting this option, you will not receive photos of your child in our parent communication app - Seesaw Photo Consent SignatureCAPTCHA
