Name: Virtual PA Day Art Activities
SKU: VPAD-25SEP2020
Price: 45.00 CAD
Availability: InStock

Child Details

Name of child*

First Last

Date of birth*

Parent/guardian*

First Last

Gender identification*

Male
Female
Child does not identify as male or female
I prefer not to disclose

Address*

This is the home address the child will be connecting from each day.

Street Address Postal Code

Telephone number*

Email*

Agnes will be using this email to send information about the virtual program including the link to the class.

Photography

We would like to photograph the program in action. These photographs will be used in the following manner:

In the Art Centre newsletter At Agnes.
As publicity photographs.
For documentation of our programs, use in future funding applications and reports, and use in educational workshops.
On our website and in social media.

The children will not be individually identified in reproductions for these purposes.

I give my consent to photography with my signature below.

Parent / guardian signature for photography (screenshots)

Cancellation Policy:
Up to two weeks prior to start of the course or camp: full refund less $75.00 administration fee. Less than 14 days prior to start of the course or camp: 50% of fee. Less than 48 hours prior to start of the course or camp: no refund.
Collection of Information:
Personal information is collected under the authority of the Queen’s University Royal Charter, 1841, as amended, and will be used for the purpose of registration, administering AGNES programs, program-related activities, and safety. Questions regarding the collection or use of this personal information should be directed to camps@queensu.ca 613-533-2005.

*

I have read the Cancellation Policy and Collection of Information Policy

How did you hear about the program?

At Agnes newsletter
Agnes website
Queen’s camp listings
Email from the Agnes
Facebook post from the Agnes
Ad in Recreation and Leisure magazine
Other

Other (please specify)*

Please email me about future programs and events

Virtual/Online Program Registration Agreement

By submitting this form, I am agreeing to register a child for whom I am legally responsible (“my Child”) to participate in the Agnes Art Camp at Home program (the “Program”), as operated by Queen’s University at Kingston (the “University”). I understand that participation in the Program entails remote learning and individual activities (the “Program Activities”) which may be undertaken at the location of my choosing. In registering, I agree to ensure that my Child undertakes Program Activities safely and responsibly, in accordance with the terms set out herein, any applicable University policy, any direction provided by University personnel, and taking due care to appropriately supervise my Child and use my own judgment. I understand that University personnel cannot and will not directly supervise all of the Program Activities, which may include the use of devices, tools, and materials, whether or not such items are provided by the University, and I agree that I am solely responsible for any loss, damage, or injury that may result from my Child’s participation in the Program Activities.

Internet use carries with it inherent risks. During this program, my Child will access the internet and interact with other youth in a structured online environment. I take responsibility to structure my Child’s internet access in an age-appropriate manner and will talk to my Child about online privacy and responsible online engagement.

When my Child is using a personal or University-owned device and while accessing content or resources supplied by the University including but not limited to online platforms and communication tools or accounts (“University resources”), I agree that I will ensure that my Child will:
a. use University resources only as authorized;
b. maintain the confidentiality of any assigned authentication credentials and will not share them with others;
c. use only their own authentication credentials;
d. respect the copyright and intellectual property rights of others;
e. respect the licensing agreements and terms for all software, and only install and use software as permitted in the license agreement for that software;
f. respect the licensing agreements and terms for all electronic resources including databases, journals, books and other print, audio and video content;
g. not use University resources for any activities or actions which are illegal or do not comply with Canadian or Ontario legislation; and
h. not use University resources to do anything that is a violation of the rights of others, such as displaying or distributing obscene, harassing, defamatory, or discriminatory material or messages.

I understand that if my Child contravenes any of the terms herein, my Child’s participation in the Program may be terminated by the University without notice or compensation. I further agree that if I become aware of any such breach by any other person or entity, I will report the incident to camps@queensu.ca and the individual camp contact for which I am registered as soon as reasonably possible. I understand that the University will take reasonable precautions to prohibit all persons and entities from engaging in a breach of these terms, and I acknowledge that if a breach nevertheless should occur, that the University shall not be liable for any damages resulting from such breach, including but not limited to physical injury, psychological harm, property damage, data loss, theft of personal information, breach of privacy, or damage to intellectual property or devices. I agree that I have explained the terms of participation in the Program to my Child and my Child has agreed to comply with them. I acknowledge that I am solely responsible for determining my Child’s level of participation in the Program Activities and agree that I will supervise my Child during my Child’s participation in any Program Activities in a manner that is appropriate to the age and maturity of my Child and the level of risk, as determined by me in my own discretion. I will be easily available if my Child summons me and participation in this Queen’s online program is not a substitute for guardian supervision.

Having read and understood this document, and in consideration of Queen’s permitting my Child’s participation in the Program Activities, I agree to waive, and hereby release and forever discharge all claims I may have for every kind of damages, loss, injury, or expense (“Claims”) arising from my Child’s participation in the Program Activities as against the University, its employees, and agents, and all of their successors, heirs and assigns (together, “Queen’s University”). Further, I agree to indemnify and save Queen’s University harmless from any Claims that may be brought by any third party, including by or on behalf of my Child, arising from my Child’s participation in the Program Activities. I agree that all of the provisions of this Agreement shall be interpreted pursuant to the laws applicable in Ontario and any disputes as to its interpretation or application shall be decided exclusively in Ontario, and if any part of this agreement is found to be invalid or unenforceable, the validity and enforceability of the remaining provisions shall not be affected.

Date

Name of child*

First Last

Parent/Guardian Name*

First Last

Signature (Virtual/Online Program Registration Agreement)*

Registration Total

Product Name

Phone

This field is for validation purposes and should be left unchanged.

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