I, the under signed parent/guardian of
do hereby consent to his/her participation in the Yarmouth Association for Community Residential Options Summer Respite Program.
I acknowledge that participation in this program may expose the above named youth/child to the possibility of injury. I grant Yarmouth Association for Community Residential Options Summer Respite Staff the authority to obtain emergency medical treatment as necessary to ensure that the above named child/youth is safe from further injury.
In consideration of Yarmouth Association for Community Residential Options and the permission to allow this child/youth to participate in its Summer Respite Program, I agree to waive and release Yarmouth Association for Community Residential Options from all claims for damages that may arise.
Medication will only be administered if it has been prescribed by a qualified medical practitioner, is in its original container and I have a signed permission form with directions.
parent/guardian, authorize Respite Coordinator/Summer Respite Staff to administer
(medication) to my child
with the following instructions:
YACRO is actively following the COVID-19 guidelines set out by Public Health to ensure the health and safety of our clients, staff, program participants, and their families. Some individuals are considered at higher risk of severe illness with COVID-19 including those over 65 and those with compromised immune systems or underlying medical conditions. If you have concerns about your own health, your child’s health, or the health of other household contacts, please consult with your health care provider, or contact 811 for further direction.
Please review the following information for the Summer Respite Day Camp 2022. Upon signing of this document it will automatically be sent to the Respite Coordinator at email@example.com. Your child will be unable to attend camp until we have received all signed documentation and waivers.
The Summer Respite Day Camp will be following the current public health guideline for group sizes of individuals. Hours of Summer Day Camp will be 8:30am-4:30pm.
A daily wellness assessment questionnaire will be required to be completed by parent/guardian upon camper drop off. All staff will also be required to complete a daily wellness assessment to monitor for any symptoms of COVID-19. Any staff or participant exhibiting symptoms consistent with COVID-19, will be asked to complete the online COVID-19 assessment form to determine if they require a test for COVID-19. If they do require a test, the participant or staff will be asked to return home until they receive negative results from their COVID-19 test. The Nova Scotia Government is encouraging everyone to get a COVID-19 test regardless of symptoms.
Masks:Staff will be unable to physically distance from your child to ensure the proper care and support is being given. By signing this agreement, you are allowing the respite recreation staff and the Respite Coordinator to be within 6 feet of your child. Staff will be assigned to a camper for the entirety of the week. There will be times when staff may be required to support & supervise other children who they are not assigned to in order to provide opportunities for staff to take short breaks.
— Staff will be unable to physically distance from your child to ensure the proper care and support is being given. By signing this agreement, you are allowing the respite recreation staff and the Respite Coordinator to be within 6 feet of your child. Staff will be assigned to a camper for the entirety of the week. There will be times when staff may be required to support & supervise other children who they are not assigned to in order to provide opportunities for staff to take short breaks.
— Drop off and pick up will take place through the side door of the building located near the wheelchair ramp. **Please note: the YACRO Hub facility is also regularly utilized for training, meetings and maintenance. There will be other individuals in and around the building at times. Please ensure you also maintain physical distance with these individuals.
— Respite Staff are aware of the dates and times that other YACRO individuals will be in and around the building for trainings and meetings. They have created the schedule in accordance with this to ensure there will be no contact between your child and these individuals.
— Upon entering the YACRO Hub facility, we ask that you please sanitize and/or wash your hands. Hand sanitizer will be provided upon entry. Regular hand washing with your child will be facilitated throughout the day. Staff will also be required to regularly wash their hands.
— Staff will ensure all necessary sanitary measures are implemented throughout the day, such as avoiding sharing, avoiding touching face, proper hand washing, regular waste removal, and frequent cleaning of highly touched surfaces. Toys and equipment used will be sanitized between use.
— A detailed & thorough COVID cleaning checklist will be completed twice daily.
If your child develops symptoms consistent with COVID-19 while at camp, you will be asked to come pick them up. Staff will monitor your child in a separate room from the rest of the participants until you arrive. You should then contact 811 for an assessment, or complete the online assessment tool located here: https://covid-self-assessment.novascotia.ca/en.
Thank you for helping our team in following these changes to ensure we are able to provide a safe Summer Respite Day Camp this year. We are excited to be able to provide a Summer Camp this year and look forward to seeing all of this year’s campers!
I acknowledge that the above named child/youth will be participating in activities and events organized by the Yarmouth Association for Community Residential Options Summer Respite Staff. I am aware that the participation of my child/youth may be outside the scope of his/her regular routine. I give permission for my child to be driven by Summer Respite Staff/Respite Coordinator to a program location when the daily program activities require transportation.
I acknowledge and confirm that I have read this entire document prior to signing.
There may be activities during the Summer Respite Program where photos and videos may be taken. To do this we are asking your permission to photograph and/or videotape your child/youth when participating in Summer Program activities. YACRO hosts a Day Camp Blog on our website located at respite.yacro.com. Some of the photos taken throughout the Summer will be used on the blog.
give my permission for my child to be photographed or videotaped in a group or individual setting by the YACRO Summer Respite Program staff, and used on the YACRO Respite Blog.
* Fill the spaces below ONLY to deny your consent to share photo/video.
DO NOT GIVE my permission for my child to be photographed or videotaped in a group or individual setting by the YACRO Summer Respite Program staff, and used on the YACRO Respite Blog.
Respite Coordinator, Western Region
Reach out to us for any questions or concerns.
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