Senior Youth Interpreters Program

2022 Application Form

Upper Canada Village

YOUTH INFORMATION Please make a separate copy for each additional child.

Name*
Gender Identity*

SESSION PREFERRED

(Please indicate 1st and 2nd choice.)
(Please indicate 1st and 2nd choice.)
  1st Choice 2nd Choice
Session 1 - June 4, 5, 11, 12, and June 18, 19
Session 2 - June 25, 26, 27, and July 2, 3, 4
Session 3 - July 16, 17, 18, and July 23, 24, 25
Session 4 - August 6, 7, 8, and August 13, 14, 15
Any session is acceptable

PLEASE PROVIDE THE FOLLOWING:

Address*

PARENT/GUARDIAN INFORMATION

Parent/Guardian 1*
Parent/Guardian 2

EMERGENCY CONTACT

Name*

PERSON(S) AUTHORIZED TO PICK UP MY CHILD

Name*
Name

WAIVER OF LIABILITY:

In permitting my child to attend the 2022 Youth Program operated by Upper Canada Village, I wish for my child to participate in all program activities unless I have provided written notice otherwise. My child will follow all Covid-19 guidelines as required during the time of the program. I will not send my child to the program if they are displaying any symptoms of Covid-19. I authorize the Program Director, or his/her designate, in the event of accident or illness affecting my child, to authorize all procedures and related expenses, including admission to hospital and treatment as deemed necessary for the well being of my child. Such action is to be taken only when immediate contact with the undersigned cannot be made. I agree that, having taken such precautions as in your discretion are deemed advisable, Upper Canada Village will not be held responsible for any accident or illness to my child. I also understand and agree that any pictures taken may be used for promotion of Upper Canada Village. I waive any right to compensation and/or the right to inspect or approve the finished printed material.

As a legal guardian, I authorize the above named person(s) to pick my child up from the Program. I also declare that I have read and understood, and consent the Waiver of Liability above.


Use your mouse or finger to draw your signature above

Please note that Upper Canada Village does not provide accommodation for Senior Youth Interpreters. It is the parents’/guardians’ responsibility to arrange for transportation and/ or accommodation for their children.


For more information e-mail to: UCVyouthprograms@parks.on.ca

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