MUST FILL OUT ALL DETAILS IN ORDER TO BE REGISTERED

 

Is this the child’s first visit to Camp Connections? ¨ Y ¨ N

 

Camper Info:

Name                                                                                               Sex: M ¨ F ¨

Date of Birth: (mm/dd/yy)            /       /             Age at time of camp:                          

Health Card #: _______________________________________

Cultural heritage (i.e. Dene, Inuit, etc) _____________________          

Child’s Status (circle one):

Permanent       Temporary      Voluntary      Support Services     Birth/Adopted     Plan of Care

Caregiver Info:

Caregiver:                                                            Circle: birthparent / fosterparent / extended family

Home phone:                             _________ work/cell:                                        ____________

Emergency phone: __________________________________________

Mailing Address:                                                               Community:                                         

Postal Code:                                                                                  

Social Worker Info (If applicable):

Social Worker:                                                                 Phone:                                                                

On call phone: _________________________ Emergency phone: __________________________

Email: ______________________________      Fax: ________________________________

Mailing address:_____________________________________________________________

Summer Schedule 2008

Check to register	Start Date/Time	End Date/Time	Program
	July 3	July 8	Boys and Girls (age 7 – 12)
	July 12	July 17	Young Women’s Week Includes canoe trip wx permitting, (all females age 13 – 18)
	July 21	July 26	Boys and Girls (age 7 – 12)
	July 31	August 5	Young Men’s Week Includes canoe trip wx permitting, (all males age 13 – 18)
	August 9	August 14	Boys and Girls (age 7 – 12)

 

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