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Contact

Eastern Zone Community Centre 
Community Enrichment Programmes 

Register for CEP Programme of Interest 

MORE INFORMATION BELOW

Emergency Contact 

Child Under 18 Years 

Parent/Guardian Name

Employer

How will your child get home?

Prescription / Regular Medication (Staff is not allowed to administer medication)

Emergency Permission 

I understand that in the event medical treatment is required, every effort will be made to contact the Emergency Contact person. However, if they cannot be reached, I give permission to the staff or facilitators to secure the services of a licensed physician to provide the care necessary (including anesthesia) for my well-being. 

Photo Release Agreement | Photography and or Video Clips Taken during Programme Activities 

I grant permission for The Office of Youth Affairs (TOYA), its representatives, and employees the right to take photographs/video clips featuring the participants and or their property in connection with our programmes. I authorize TOYA, its assigns and transferees, to copyright, use, and publish the same in print and/or electronically. I agree that TOYA may use such photographs of the participants with or without his or her name and for any lawful purpose, including for example such purpose as publicity, illustration, advertising and web content. I release any and all claims against The Office of Youth Affairs for utilizing this material for educational purposes. 

The Office of Youth Affairs properties are smoke, drug and alchohol free. By Signing below, you agree to abide by these rules and instructions given by the facilitator or his or her designates. Any violation of these rules may result in you being dismissed from the programme and property and you will be liable to any costs involved in your repatriation (as applicable)

I have read, understood and agree to the information outlined on the Programme Registration Form, and certify that the information I have given is true and correct. 

Thank You for Registering!

Contact Information 

Sammy Wilson Central Zone Community Centre:  441 734-0059

Eastern Zone Community Centre 441 734-0060/61

Western Zone Community Centre 441 734-0058 

Head Office 246-9100

Email: cep@gov.bm

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