Kids Cornercwec - children's water education council

Environmental Leadership Camp Application

Date: 4 pm Friday April 20 – 4:30 pm Saturday April 21, 2012
Location: Waterloo Region Museum, 10 Huron Road, Kitchener
Phone: 519-748-1914

Please fill in the below fields, submit it, and print out the paper copy to bring with you to the camp.
Contact Information
Name First:  Last:
Address
 
City
PostalCode
Phone
Email
School
Grade
Parents
Mother
Name First:  Last:
Phone Home:  Work:
Father
Name First:  Last:
Phone Home:  Work:
LegalCustody
Alternate Emergency Contact
Name (not parent)  Phone:
Doctors Name  Phone:
Eating Concerns
   
Details
Health History
please let us know if there are any concerns that we should be aware of
Details
Are there any treatments, injectiosn or special medical instructions to be given at camp?
   
Please state when and how often they are to be administered.  Medication should be brought to camp in the original container with a doctor's instruction.
Details
Participation request
Describe why you would like to be part of the Environmental Leadership Camp:
 
Describe a situation when you acted as a leader:
 

 
    Design, Hosting and Maintenance by techStudio   
The Children's Water Education Council gratefully acknowledges the financial support of the Ontario Trillium Foundation, an agency of the Ministry of Tourism, Culture and Recreation. With $100 million in annual funding from the province's charitable gaming initiatives, the Foundation provides grants to eligible charitable and not-for-profit organizations in the arts, culture, sports, recreation, environment and social services sectors.