March Break Camps Registration Form 2025

All programs require pre-registration with full payment in advance. Program size is limited so early registration is recommended.

The museum will be running 2 days of March Break children's camps. Each day has a separate theme. You can register for both days or just one.

Dates:

Thursday, March 13, 2025 10 am - 3 pm Theme: March Break Madness

Friday, March 14, 2025 10 am - 3 pm Theme: St. Patrick's Day

Cost: $40 per day or $70 for both days.

*If weather permits please send your child with appropriate outerwear and a change of indoor shoes as some activities may take place outdoors.

Which date(s) are you signing up for?

Thursday, March 13, 2025

Friday, March 14, 2025

Child's Name:

Child's Age and Grade:

Healthcard Number:

Are there any allergies, concerns, medication, or special needs?

Can they have outside food sources (candy, popcorn, etc.) provided by staff?

Yes

Family Information

Parent/Guardian Name:

Email:

Phone Number:

Address:

Family Doctor Name:

Family Doctor Phone Number:

Parent/Guardian Consent:

I have provided all of the health, behavioural and physical needs information which pertains to my child that is necessary for the leadership of this program to provide a safe experience for my child and other participants.

I understand that the program leaders will use their best judgment for maintaining a safe environment for each child. This may include refusing my child the privilege of participating in a portion of the program if they are behaving in an unacceptable manner.

I understand that the Smiths Falls Heritage House Museum will follow all guidelines published by the Ministry of Health.

I understand it is up to my own discretion on sending my child to the Heritage House Museum Day Camps.

I hereby give my permission:

To administer medication provided by me in accordance with proper and complete instructions that I will provide.

To administer first aid if necessary.

To take my child off museum property for prearranged activities if indicated.

To photograph/film my child while participating in a museum program, for promotional purposes.

To all local newspapers to print photos/articles related to my child.

To allow the Heritage House Museum to put photos on their website/Facebook page.

Payment Information

To complete registration, choose one of the following;

Visit us at Heritage House Museum to pay with cash, cheque, credit, or interac
Mail form with cheque to: Heritage House Museum, 11 Old Slys Road, P.O. Box. 695, Smiths Falls, ON, K7A 4T6

Your signature indicates your agreement with all above statements.

Clear