Genius Hours – STEM Camp Registration Form

Which July 13-17 STEM camp is your child attending?

AM Half-day Camp only - $199.00
PM Half-day Camp only - $199.00
Full-day Camp - $349.00

Child Information

Name

First

Last

Preferred Name / Nickname if applicable

Date of Birth

Grade entering in September 2026

Cell Phone if applicable

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Medical Information (e.g. allergies - food, environmental, etc.; conditions; required medication)

Accessibility needs and/or accommodations

Learning or behavioural needs and/or accommodations

Waiver of Liability

I, parent/guardian of the camper named above, agree to hold harmless, indemnify and release MindFuel and its employees or contractors from any and all claims of liability for any personal injury, loss or damage to property or for any personal obligation, incurred or suffered in connection with or during the MindFuel Genius Hours STEM Camp at The MindFuel Foundation office.

camp Address

Understanding and agreement

I agree to the waiver of liability above

Photograph, Video, Name and/or Quotation Release Form

I, parent/guardian of the camper named above, hereby give permission to The MindFuel Foundation to use their name, image or quotation in its public relations and communication materials created in perpetuity from date consent is signed. I realize that I may withdraw my consent in writing at any time by contacting The MindFuel Foundation.

I understand that the photograph(s), and / or quotation from this MindFuel School Program from the MindFuel Genius Hours STEM Camp and/or social media thereof may be used in a publication, print advertisement, direct-mail piece, television broadcast, electronic media (e.g., video, CD-ROM, internet, World Wide Web, Social Media, etc.) or other form of communication.

All communications by The MindFuel Foundation where this material will appear shall constitute the property of The MindFuel Foundation, solely and completely. I hereby relinquish any and all personal or proprietary rights I may have in connection with such use. I understand that I will receive no compensation should any of this material be used. I realize that I may request access to communication at any time by contacting The MindFuel Foundation.

In giving my consent, I hereby release and hold harmless The MindFuel Foundation and their agents, employees, officials, representatives and contractors from any and all responsibility or liability for damage of any kind suffered in any manner whatsoever.

I understand that because this material will be available to the public in The MindFuel Foundation's communications, it is not possible to consider an expiry date for this consent. Cancellation of my consent may only limit the use of my information in the future or new publications.

Photos and video recordings will be taken at the camp.

I agree to the media waiver form above
I request that my child not to be included in photos or videos.

Parent/Guardian Information

Name

First

Last

Email

Cell Phone - Primary Contact Number

Secondary Contact Number

Emergency Contact (must be different from Parent/Guardian Information above)

Name

First

Last

Cell Phone - Primary Contact Number

Secondary Contact Number

Authorization Pickup Person (if different from above listed)

Name

First

Last

Cell Phone - Primary Contact Number

Secondary Contact Number

Camp Practices and Policies

1. Supervision & Group Structure

Campers participate in structured, supervised group activities at all times.
Activities are designed for collaborative learning, and students may work in small groups.
There is a maximum of 20 campers per session. The instructor-to-camper ratio is 7:1 to ensure safety and engagement.

2. Sign-In and Sign-Out Procedures (Mandatory)

Daily sign-in and sign-out is required for all campers.
Campers must be signed in and out by a parent/guardian or authorized individual listed on the registration form. Photo ID may be required for verification at pickup.
Campers will not be released to unauthorized individuals under any circumstances.

3. Camper Participation & Safety

Campers are expected to:
- Treat others with respect
- Follow instructors instructions
- Work cooperatively with peers
- Use equipment responsibly
Unsafe or disruptive behavior may result in removal from an activity or, in serious cases, dismissal from camp.
Parents/guardians will be contacted if behavior concerns arise.
All medical conditions, allergies, and special needs must be disclosed during registration.
The instructors are not able to administer medications. If a camper requires medication administration during camp hours, please contact MindFuel in advance to organize a process and timing in which a confirmed individual will administer the medication.
A basic first aid kit is available on-site at all times.
If there is an injury or emergency, parents will be contacted immediately. If hospital assistance is required, MindFuel will follow their Emergency Policy, and ensure that the camper is receives medical care.

4. Communication with Parents/Guardians

Main communication prior, during and after the camp will be via email, challenge@mindfuel.ca.
During the camp week, parents will also receive a cell phone number in which they can communicate with the instructors.
Instructors will communicate any:
- Program details and updates
- Injuries or incidents
- Behavioral concerns
- Emergency situations

5. Registration fee

Payment of the registration fee is required to finalize camper registration.
Bursaries are available for individuals requesting financial assistance. Please contact MindFuel directly at challenge@mindfuel.ca.

For all questions, please contact challenge@mindfuel.ca.

Payment Information

Payment is required to finalize registration.

Total

$0.00

Promo Code

Credit Card

Parent / Guardian's Signature

Clear Signature

Date