AKM SUMMER CAMP
REGISTRATION FORM 2022
On-site Form
SUMMER CAMP 2022
The 2022 Aga Khan Museum Camp welcomes kids back to the Museum for summer fun with friends old and new. Our up-to-date health-and-safety measures include gathering in smaller group sizes, physical distancing, and easy access for washing hands.
This year’s Camp theme is “Image.” What power do images have in shaping our imagination? How do they represent our identities and values? What lessons can we learn from and communicate through them? Explore these questions and more at the Aga Khan Museum during a week filled with engaging art activities, cultural exploration, and self-reflection.
On Site Camp
Spark your imagination at the Aga Khan Museum Summer Camp and explore images and stories across time and place. As Campers venture into a dazzling world of images in our IMAGE? The Power of the Visual exhibition, they will learn about courageous heroes, powerful leaders, and loving people who have always imagined a more hopeful future. Across a 5-day journey, Campers will reflect on their own identities and future as they create art in different ways, using painting, sculpture, photography, and drama to express themselves.PHOTOGRAPHY AND VIDEO PERMISISSION:
During the course of the Aga Khan Museum (“Museum”) Summer Camp and related activities, images may be taken of your child(ren) as well as your child(ren)’s works of art for use in the marketing, advertising, promotion of Museum programs, fundraising campaigns, and exhibitions. No personal identifying information (i.e., full name/address) will be associated with the use of the image(s). To signify your consent please sign where indicated below.
I, the undersigned on behalf of my minor child(ren), give permission to the Museum to use, share, disclose, and publish photographs, videos, and other recordings (including audio) of my child(ren) and their likeness and their works of art, without restriction. I also give permission to the Museum to modify and edit (e.g., crop, adjust coloring, etc.) or create derivative works of same as needed or as may be desirable to promote the Museum, its programs, and offerings and for other non-commercial purposes to advance the Museum’s mandate and purpose. I hereby waive any right to inspect or approve the use of the images or recordings or of any written copy.
By giving this consent on behalf of my minor child(ren), I understand and acknowledge that:
I am hereby irrevocably granting permission to the Museum the right to use and incorporate (alone or together with other materials) to perpetually, exclusively use photographs, video, and/or other recordings taken of my minor child(ren) and their works of art (in whole or in part) as a result of their participation in activities/events of the Museum or otherwise for all media throughout the world whether presently in existence or invented in the future.
I understand that neither I nor my child(ren) will be paid any compensation of any kind and I, on behalf of myself and my child(ren), waive any right to royalties or other compensation arising from or related to the use of the images, recordings, or materials. I acknowledge that the Museum owns all rights to the use of the images and recordings.
I, on behalf of my minor child(ren), forever release and discharge the Museum and all of its directors, officers, employees, members, agents, volunteers, and representatives (collectively, the “Releasees”) from any and all liability for any claim, action, demand, or controversy, including claims of invasion of privacy or violation of publicity rights, that I or my minor child(ren) might otherwise have in connection with the use of my minor child(ren)’s photos, videos, recordings, likeness, and artwork. This consent, waiver and release is binding on me, my child(ren) and our respective heirs, executors, administrators, and assigns and shall survive termination of the Summer Camps. The terms of this consent, waiver and release are in addition to any other consents, waivers, releases and indemnities I have given in connection with my child(ren)’s enrollment, participation and/or involvement in the Summer Camps. If there is a conflict on inconsistency between the terms contained in this document and the term(s) contained in any other document, I understand and agree that the terms that provide the Museum with the greatest set of rights and protections shall prevail.
*by not checking the above you have the capacity and legal authority to DECLINE this agreement.
HEALTH INFORMATION, EMERGENCY PLANS AND HEALTH PERMISSION FORM (REQUIRED)
The personal information contained on this form and the registration form will be used to respond to medical and emergency situations, to help support the efforts of Public Health Authorities and other government bodies and agencies in stopping the spread of COVID-19, to understand your child’s unique needs which may impact their participation or those of others in the Summer Camps, to help safeguard the wellbeing of all campers, staff and personnel, and to help administer the Summer Camps as effectively as possible. . The personal information collected in connection with your child’s registration in the Summer Camps is collected in accordance with the principles of applicable privacy law.
This form must be completed and submitted for each child prior to the start of the Summer Camps. The form will be kept on file together with the child’s Summer Camp registration form, and copies of same may be shared with the Camp Supervisor(s) and educators. The personal information collected in connection with your child’s registration in the Summer Camps is collected in accordance with the principles of applicable privacy laws Such personal information will only be retained for as long as is necessary for the purpose for which it was collected, after which it will be destroyed, erased, or de-identified (unless retention is needed for legal or compliance purposes).
Please provide detailed information and describe the necessary action required in the event of a medical emergency or allergic reaction. In addition, please speak with the Museum Camp Supervisor regarding your child’s allergies, medical conditions, and necessary medication.
ANAPHYLAXIS EMERGENCY PLAN (complete if applicable)
The registrant child has a potentially life-threatening allergy (anaphylaxis) to (check the appropriate boxes):
Person is at greater risk. If person is having a reaction and has difficulty breathing, give epinephrine auto-injector before asthma medication.
Food
The key to preventing an anaphylactic emergency is absolute avoidance of the allergen. People with food allergies should not share food or eat unmarked/bulk foods or products with a “may contain” warning. Please note that the Museum is not a Nut-Free environment.
Epinephrine Auto-Injector:
Dosage:
Location of Auto-Injector(s):
MUSEUM EMERGENCY RESPONSE PLAN TO AN ANAPHYLATIC REACTION
A person having an anaphylactic reaction might have ANY of these signs and symptoms:
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*Skin: hives, swelling, itching, warmth, redness, rash
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*Respiratory (breathing): wheezing, shortness of breath, throat tightness, cough, hoarse voice, chest pain/tightness, nasal congestion or hay fever-like symptoms (runny, itchy nose and watery eyes, sneezing), trouble swallowing.
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*Gastrointestinal (stomach): nausea, pain/cramps, vomiting, diarrhea.
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*Cardiovascular (heart): pale/blue skin colour, weak pulse, passing out, dizzy/lightheaded, shock.
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*Other: anxiety, feeling of “impending doom,” headache.
Act quickly. The first signs of reaction can be mild, but symptoms can get worse very quickly.
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1Give epinephrine auto-injector (e.g., EpiPen® or TwinjectTM) at the first sign of a reaction occurring with a known or suspected contact with allergen. Give a second dose in 10 to 15 minutes or sooner.
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2Call Museum Security 7777, or if outside the Museum, call 911. (Explain that someone is having a life-threatening allergic reaction. Ask them to send an ambulance immediately.
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3Go to the nearest hospital even if the symptoms are mild or have stopped.
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4Call emergency contact person. The undersigned parent or guardian authorizes the Aga Khan Museum staff or representatives to administer epinephrine to the above-named child in the event of an anaphylactic reaction, as described above.
Please review this Emergency Plan with your physician.
COVID-19 PRIVACY DISCLOSURE
From time to time, the Museum might be asked to share details about our visitors and invitees including Summer Camp participants with government authorities such as the Public Health Authorities in order to support their COVID-19 emergency response efforts. In other instances, the Museum might become aware of a visitor, invitee, or personnel member who has a confirmed case of COVID-19 or who has come in close contact with a person who has a confirmed case of COVID-19. The Museum is committed to informing our visitors of any such confirmed cases that pose a health and safety risk. Such notification will be done in an anonymized and non-identifiable manner and in accordance with applicable privacy laws.
In addition to other consents provided by you on the collection, disclosure, use, and storage of your and your child’s personal information, you understand and agree that the personal information you share with us may also be disclosed to, and used by, Public Health Authorities where required or permitted by law. Subject any other permissions you have given us, the Museum will only retain such personal information for as long as is reasonably necessary for the purposes of administering the Summer Camp, protecting the safety and wellbeing of the Museum’s visitors or for as long as required by law. Any questions regarding the collection, use, disclosure, and storage of personal information may be directed to [email protected].
HEALTH PERMISSIONS, CONSENTS AND ACKNOWLEDGEMENTS (REQUIRED)
I, the undersigned, agree as follows on behalf of myself (where applicable) and my child whom I am registering for the Summer Camp(s):
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a.I have read and understood the Health Form and agree to the terms therein contained.
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b.I understand, accept and agree to the COVID-19 policies, protocols and procedures that must be followed by my child and anyone (including myself) that enters the Museum to facilitate my child’s participation in the camp (e.g. those responsible for pick-up and drop-offs).
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c.I understand and agree that I will immediately inform the Museum if:
i. My child or anyone in my household experiences any symptoms of COVID-19 or other contagious disease;
ii. If I or anyone in my household has been notified as a close contact of someone with COVID-19 or been told to stay home and self-isolate; and/or
iii. I or anyone in my household travelled outside of Canada during the period of the Summer Camp or within the relevant 14 day periods,
and I further understand and agree that in the event of any of the above, the Museum will be required to follow the advice of public health authorities which may require the discontinuation of my child’s participation in the Summer Camp. In such case, the Museum’s refund policy will apply. -
d.I understand and acknowledge that in the event that my child experiences any symptoms that Summer Camp personnel reasonably believe to be COVID-19 related, my child will be isolated from other campers and personnel and will required to be immediately picked up from the Summer Camp and that is my responsibility to organize such transportation.
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e.I understand and acknowledge that while the Museum is a nut aware environment, it is not a nut-free environment.
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f.I have read and understood the Museum’s emergency response plan in the event of a person having an anaphylactic reaction and agree that it meets the standard of care required for my child.
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g.I give permission to the Aga Khan Museum to share this completed Health Form to attending Aga Khan Museum staff, agents and volunteers who have a need to know such information in connection with the implementation of the Summer Camp(s) in which my child is participating.
HAND SANITIZER PERMISSION FORM
The Toronto Public Health Department requires camp programs to use hand sanitizer that has a minimum 70% alcohol when soap and water is not available. Research shows that sanitizers that have an alcohol content of less than 70% are not effective in killing germs. As always, we will continue to teach and encourage effective hand washing wherever possible.
If you require any further information, or if you have any questions, please contact the Education department at [email protected]
CAMPER CODE OF CONDUCT – HEALTH RULES
The best way to prevent infection is to avoid being exposed to and spreading the virus. Please help us re-enforce safe COVID - 19 etiquette by going over the following code of conduct with your child and with anyone who might enter the Museum to facilitate my child’s participation with the camp (including those responsible for pick-up/drop-off).
In order to help prevent the spread of COVID-19, we agree to follow the following camp health rules and prevention measures.
- Wash your hands often with soap and water or use an alcohol-based hand sanitizer.
- Avoid touching your eyes, nose, and mouth with unwashed hands.
- Practice physical distancing and avoid contact with people who are ill.
- Avoid shaking hands or touching others.
- Wear masks as recommended by the public health authorities.
- Stay home when you are ill or have been in close contact with someone who is ill or have been in close contact with anyone who has travelled outside Canada within 14 days of my child’s participation in the Summer Camp.
- Inform the Museum of any suspected case of COVID-19 involving my child’s household.
- Cover your cough or sneeze with a tissue, then immediately throw the tissue in the garbage and wash your hands. If you don’t have a tissue, sneeze or cough into your sleeve or arm.
- Clean and disinfect frequently touched objects and surfaces.
- Adhere to the public health guidelines and requirements of the City of Toronto and the Province of Ontario.
- Complete a daily assessment each day before arriving at camp.
