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"Aliyana Seh Anya"- "Love is All Around"
Pender Island
August 26-28
Registration for 1 child or up to 2 additional siblings
Child's First Name
Parent/Guardian First Name
Parent/Guardian Email
Child's Last name
Parent/Guardian Last name
Parent/Guardian Phone Number
Emergency Contact Full Name + Relationship to Child
Phone
2nd Emergency Contact Full Name + Relationship to Child
Home Address
Phone
Child Date Of Birth
Sibling attendance for same camp week with same guardianship, home address, and family doctor- Please write full name and date of birth if applicable
Sibling attendance for same camp week with same guardianship, home address, and family doctor- Please write full name and date of birth if applicable
Family Doctor Name and Address
Personal Health Number/Medical Insurance
Sibling Personal Health Number/Medical Insurance
Sibling Personal Health Number/Medical Insurance
Does your child require any special medical assistance at camp, i.e epipen/allergy medication- please detail below
(SIBLING ONLY) Does your child require any special medical assistance at camp, i.e epipen/allergy medication- please detail below
(SIBLING ONLY) Does your child require any special medical assistance at camp, i.e epipen/allergy medication- please detail below
What are your child(ren)'s interests related to nature? What are their general hobbies/passions outside of nature camp? What do they really love? I.e active running games/climbing trees or creating fine artwork or video games or books (which ones?) Are they into fairies/pokemon/animals/music/storytelling etc
How comfortable is your child in nature and with new children/settings? Do they have any particular fears or challenges? I.e Very comfortable around new children, Fear of wasps, uncomfortable with nature pees
Does your child(ren) have physical or behavioural challenges that will require one on one special assistance at camp?
Yes
No
If your child(ren) requires special assistance due to physical or behavioural challenges, provide further details below like type of challenges and frequency of occurance so instructors can be made aware prior to camp and can do their best at providing tailored mentorship
I have read the school waiver below, and am aware of the risks and danger my child(ren) can encounter at Alianna Earth School Summer Camp
I accept terms & conditions
Your Signature
Clear
Select date signed
Select an item (C$)
*
1 Child - C$180
2 Children - C$360
3 Children - C$540
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