Discover, June 6, 2017
To register someone for one or more camps, you will go through the following steps:
  1. You provide some personal information.
  2. You indicates for which camp(s) you would like to register.
  3. You pay on-line with either Master Card or Visa.
    Please note: American Express is not accepted!

Personal Information

*Child's first name
*Child's last name
Please note that we offer two groups of 2/3 and 4/5/6 classes for our London camps. If you wish your child to be with another friend/sibling please indicate their name here. We will do our best to accommodate, but will offer no guarantees. If not indicated on this form then no accommodations will be made for your child.
*Street Address
*City
*Province/State
*Postal Code
*Email
How did you hear about us?
*Birth date (e.g. 16-May-2001)
*Child's gender
T-Shirt Size
 
I would like to purchase early drop-off ($15.00 per week) Yes No
I would like to purchase late pick-up ($15.00 per week) Yes No

Medical and other concerns we should be aware of

*Does your child have any serious illness or health concerns the instructors should be made aware of?
If Yes, Please Specify
Yes No
*Does your child take any medication that we should be aware of?
If Yes, Please Specify
Yes No
*Does your child have any disabilities we should be made aware of?
If Yes, Please Specify
Yes No
*Are there any other concerns we should be made aware of?
If Yes, Please Specify
Yes No

Emergency Contact Information/Child Pick Up Information

*Parent/Guardian Name 1
*Home phone number
Work phone number
Cell phone number
Parent/Guardian Name 2
Home phone number
Work phone number
Cell phone number
Other emergency contact
Home phone number
Work phone number
Cell phone number
*My child is authorized to leave Discovery Western on their own Yes No
My child can only leave with the following people (photo ID will be required)

Privacy policy

Western Engineering collects the personal information of program participants and their parents or guardians under the authority of The University of Western Ontario Act, 1982, as amended, and uses it to process applications and administer and operate safe and organized programs for our participants. Western Engineering uses the information to register participants in the program as well as address potential health concerns. In the event of an emergency, we will disclose information to emergency medical personnel and to the emergency contact provided on your registration form. Western Engineering may also use parent/guardian contact information to provide details about upcoming programs and events. If you do not wish to be notified of future offerings from Western Engineering, please contact our office at 519.661.3429. Photos and videos of children may appear on television, web sites, brochures, newspapers, posters and other media to promote Western Engineering and/or The University of Western Ontario, unless you check no on the opt out box below. If you have any questions about Western Engineering’s collection, use or disclosure of personal information, please contact the Associate Director, External Services, Faculty of Engineering, The University of Western Ontario at 519.661.3429.
 
*I consent to my child appearing on television, websites, brochures, newspapers, posters and other media Yes No
 
*I have read and understand this agreement and hereby consent to have my child participate Yes

Cancellation policy

A 20% non-refundable registration deposit applies per participant when they are registered for a program. After that to receive a refund, all cancellations must be submitted in writing at least 10 business days prior to the participant's start date. No refunds will be issued to cancellations made less than 10 business days prior to the participant's start date. No refunds will be made in the event of university closure. Applicable ONLY for SUMMER Programs. If you choose to change camps (either week, location or age group) this must be submitted in writing a least 10 business days prior to the camper's start date and a $15 administration fee will be charged. Campers are not permitted to switch camps less than 10 business days prior to their start date unless there are extenuating circumstances as approved by the Director of Discovery Western and the Outreach Programs Coordinator of Western Engineering.
 
*I understand and accept the above cancellation policy Yes

Informed consent agreement

I/We the undersigned, hereby acknowledge that certain risks of injury are inherent to participation in hands-on engineering and science activities. These types of injuries may be minor or serious and may result from one’s own actions, or the actions of others, or a combination of both. I/We understand that the rules and regulations are designed for the safety and protection of participants and hereby undertake that my child will abide by these rules and regulations. I/We hereby warrant that my/our child is physically fit to participate and understand that the choice to participate brings with it the assumption of those risks and results which are part of these activities. I/We agree that the Governing Council of the University of Western Ontario, Discovery Western or Actua, their directors, officers, employees, agents, and volunteers, shall not be liable for any injury to my child or loss or damage to my child’s personal property arising from, or in any way resulting from, his/her participation in those activities, unless such injury, loss or damage is caused by the sole negligence of the University, Discovery Western or Actua, their directors, officers, employees, agents, and volunteers, while acting within the scope of their duties. I/We agree to allow my child to receive basic first aid/ medical care from instructors certified in first aid or trained medical professionals if necessary. I/We declare having read and understood the above Informed Consent Agreement in its entirety and hereby consent to participate acknowledging all the foregoing. I/We also certify that the information provided in this form is, to my/our knowledge, true and complete.
 
*I have read and understand this agreement and hereby consent to have my child participate Yes