Moorelands City VITAL Youth Application

Please complete the below application to apply for Moorelands VITAL City Youth program. If you would like to learn more about the program, click here.

Step 1 of 5

Participant Information

Participant Name

First

Last

Most Commonly Used Name (if different from First Name)

Sex

Grade

As of September 2025

Date of Birth (mm/dd/yy)

As part of our efforts to support the participants in our High School programs, we may contact them directly through email or text message. This will help them be more successful in the program. At any time, you may request a log of communication and Moorelands Kids will provide it to you. Do you give us permission to contact your child through email, mobile app messaging services phone?

Has the participant attended a Moorelands Kids program before?

Weekly Zoom Session Time

Two Zoom calls will be offered each week at 7:00 PM. Please select your preference between Tuesday or Thursday. If your preferred day is not available, we will place you in the alternative Zoom call. If you are not available for the alternative day, please let us know.

Please select your preferred Zoom call

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Family Information

Parent 1 Name

First

Last

Parent 1 Relationship to Child

Parent 1 Primary Phone Number

What type of phone number is it?

Parent 1 Secondary Phone Number

What type of phone number is it?

Parent 1 Email

Confirm Email

Parent 1 Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Parent 2 Name

First

Last

Parent 2 Relationship to Child

Parent 2 Primary Phone Number

What type of phone number is it?

Parent 2 Secondary Phone Number

What type of phone number is it?

Parent 2 Email

Confirm Email

Is the address the same as parent 1?

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

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Conditions of Registration

Please read the following conditions of registration and sign your name below:

1. I give permission for the above-named child to participate fully in both on and off site activities and trips, unless otherwise indicated in a separate note in writing.
2. I give permission for the above-named child to participate fully in questionnaires or surveys, unless otherwise indicated in writing.
3. I give permission for emergency medical treatment to be carried out, should it be required, with the understanding that Moorelands Kids will attempt to contact me at the telephone numbers listed on my application. Having taken all reasonable precautions, neither Moorelands Kids nor any organization working with Moorelands Kids shall be held responsible for any accident or sickness.
4. I give permission for a representative from Moorelands Kids to share/obtain information about the above-named child from this child’s emergency contact as indicated on this form.
5. I, on my behalf and on behalf of the above-named child, agree to the use of photographs, digital images, video or audio recordings (“Images”) of the child, without compensation, for the purposes of public education and promotion of Moorelands Kids, now or in the future. I understand that these images may be used in print publications (e.g. newsletters, print ads, etc.) and any other form of media (e.g. television, webcast, website, etc.). I agree that any such Images shall be the sole property of Moorelands Kids.
6. The Director of Programs & Curriculum or their designate reserves the right to send a participant home who in their opinion is a safety risk to the safety or rights of others or who appears to have rejected the reasonable expectations of the program.
7. Refunds are subject to a $15 administration fee.
8. There will be no refund for cancellations received 14 days or less from the start of the registered program session. All outstanding balances will remain owing and not be reversed. You will need to pay off this balance before you are able to apply to any future Moorelands Kids programs.
9. There will be no reduction or refund of program fees for participants arriving late, leaving early, are providing their own transportation, or who are sent home.
10. If the program is closed due to current public health restrictions and conditions, you will receive a full refund for any fees paid in the 2025 year.
11. If the program is open and you cancel your child’s registration for any reason other than a medical condition your refund will be processed as per conditions of registration 7 & 8 above.
12. Any and all balances owing from previous applications and/or registrations with Moorelands Kids’ programs must be paid in full before your application is processed.
13.All applications for Moorelands Camp programs registered between January 2025 and May 2025 will require payment in full by June 1st, 2025. If payment is not received, your registration will be cancelled and moved to the waitlist until payment is received. There is no guarantee that a space will remain available.
14. All Moorelands Camp applications processed after June 1, 2025 require payment in full before being registered.
15. For ONLINE PROGRAMS, I understand that as parent or guardian of the above named child, I am responsible for the supervision and safety of this child in whichever setting and with whichever device I have decided is appropriate for the child to access the online program.
16. For ONLINE PROGRAMS, I understand that all live video-conference sessions will be recorded for safety and training purposes. All collected recordings will not be shown or used without first seeking parental permission unless it is for the purposes of training staff or ensuring the safety of both staff and participants.
17. For ONLINE PROGRAMS, I understand that any damage or loss to equipment, for example: a tablet, phone, computer, used for online programs, , is the sole responsibility of the participant and/or owner of the equipment. Moorelands Kids will not be responsible for any equipment damage that occurs during or due to the program.
18. The parent(s)/guardian(s) submitting this application are those having legal custody over the child and are legally responsible for the payment of fees and any other expenses incurred by the child.
19. I hereby certify that I have read and accept all the above conditions. The application cannot be accepted without parent/guardian signature.

MOORELANDS KIDS collects personal information about participants in its programs to be able to communicate effectively with and provide services to, these participants and the community served by MOORELANDS KIDS. For information about MOORELANDS KIDS Personal Information Policy please see our web site at www.moorelands.ca Once applications are open, completed applications are processed as received, assessed according to resources and space available. Enrollment in Moorelands Kids’ programs are at the discretion of the Director of Programs & Curriculum. Incomplete applications will not be processed.

By typing my name in the box below I agree to all the terms and conditions of registration mentioned above

Relationship to Participant

Date (mm/dd/yyyy)