Youth Getaways Participant Information Form

Please complete the following form so we have emergency contact information for your child for our Youth Getaways 2022-2023 Program.

Information and Emergency Contact Form

"*" indicates required fields

Participant Information

Child's first name*

Child's last name*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Does your child have any allergies?*

Yes

Please describe the allergies, their severity and if medication is required.

Does your child have any other medical conditions?*

Yes

Please describe the medical condition and ways to support your child.

Please let us know if your child is on any medication for their medical condition.

Parent/Guardian Information (Main Contact)

First name*

Last name*

Relationship*

Mother, father, guardian, etc

Same address as child?*

Yes

Address (if different from child)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Phone*

Parent/Guardian Information (Secondary Contact)

First name

Last name

Relationship

Mother, father, guardian, etc

Same address as child?

Yes

Address (if different from child)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Emergency Contact Information

Please provide at least one emergency contact not already listed above. Note that aside from their parents/guardians, participants will only be released to people listed as emergency contacts. Contact the coordinator to make changes to your list at any time. All emergency contacts must by 19 years or older.

#1: First name*

#1: Last name*

#1: Phone*

#1: Relationship*

#2: First name

#2: Last name

#2: Phone

#2: Relationship

#3: First name

#3: Last name

#3: Phone

#3: Relationship

Medical Permission*

If a situation should arise where it is deemed necessary to obtain immediate medical attention and staff are not able to reach parents/guardians, staff will transport your child to the nearest emergency treatment centre or contact an ambulance on your child's behalf. Emergency services will be provided with a copy of your child's health information. I authorize the staff of the James Bay Community School Centre Society, in the event of an accident or illness requiring emergency treatment affecting my child, to authorize on my behalf all procedures including admission to hospital and any necessary treatment therein as they may deem essential for the care and well-being of the child. Such action is only to be taken when immediate contact with the parents/guardians cannot be made. It is understood that JBSCS is not responsible for medical care or ambulance costs.

I agree

I do not agree

Parent/Guardian Consent*

In permitting my child to attend the Youth Getaways program at James Bay Community School Centre, I release and discharge any and all rights and claims for damages and causes of suit or action that I or my child have at any time against the James Bay Community School Centre Society, along with their employees or agents; for any and all injuries or losses suffered by my child as a result of participating in the James Bay Community School Centre programs.

I agree

I do not agree

James Bay Community School Centre Privacy Policy

Get in touch with us!

Registration & Info Line:
250-389-1470

Recreation Program Registration:
You can register for classes over the phone, at the Centre desk, or online!

To Register online:

Click here to head to our online registration system.

If you have registered with us for a program before, the email you provided at original registration will be your log-in name. Click ‘Forgot your password’ and an email will be sent where you can then create a custom password for your online account. If the email you try doesn’t work, it might be the wrong email. We would appreciate you calling the Centre desk to ask what email is on file before creating a whole new account.

If you have never registered with us before, please click the ‘Create an account’ button located on the home page.

Once you can login to your online account, you can search activities by their course number (located next to their description in the guide), category, department, or instructor!

Childcare Registration:
Click here to read about our childcare programs and to let us know that you are interested!

Refund Policy:
In order to receive a full refund for a recreation class, notice of withdrawal must be received 24 hours prior to the first class. Full refunds will also be issued if the Centre cancels a program.
When registering online there is a nonrefundable processing fee.

L.I.F.E Program Subsidies:
The L.I.F.E. program provides a combination of annual credit and program savings to eligible individuals and families. You can find more information here.

Interested in Offering a Program?

We are always interested in offering new programs! If you have a suggestion or want to teach a program or workshop, please visit our Recreation Program Proposal page.

Find Us

Address
140 Oswego St, Victoria BC V8V 2B1

Hours
September to June

Monday—Friday: 9:00AM–5:00PM
Sunday: 9:00AM–1:00PM

July and August

Monday—Friday: 9:00AM–5:00PM

Youth Getaways Participant Information Form