Vancouver Kids Summer Camp

pender island
March 17-21
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

Child Home Address

Phone

Child's 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

Family Doctor Name and Address

Child 1 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

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 or Fear of wasps or uncomfortable with nature pees etc.

Does your child(ren) have physical or behavioural challenges that will require one on one special assistance at camp?

Yes

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

Select date signed

I want to subscribe to the newsletter.

Thanks for submitting! Payment is $300/Child Please E-transfer Total to eagle@aliannahearthschool.org

pender island March 17-21 Registration for 1 child or up to 2 additional siblings

pender island
March 17-21
Registration for 1 child or up to 2 additional siblings