SWC Project Spirit 2019 - Gr. 12 Leaders & Gr.11 LITs

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Dear Parent/Guardian:

The following activity has been approved by the Administration of Sir Winston Churchill to be a valuable component in the delivery of the curriculum and/or the extra-curricular program of the school. Sufficient supervision will be provided by SWC teachers and Camp staff to ensure student safety during the trip. Parents/guardians are asked to complete the form below.

TO COMPLETE YOUR REGISTRATION, PLEASE MAKE PAYMENT THROUGH SCHOOL CASH ONLINE! (dsbn.org/schoolcash).
DATE OF ACTIVITY: September 17 - 20, 2019 DESTINATION: Camp Medeba
DEPARTURE TIME: 1:30 p.m. RETURN TIME: 5:00 p.m. (approx.)
PERSON IN CHARGE: Tammy Short COST TO STUDENT: $350.00
TRANSPORTATION: Coach Bus

If there is any further information you require please email Ms. Short at tammy.short@dsbn.org.

Email *

Student's Last Name *

Student's First Name *

Student's Date of Birth (mm/dd/yyyy) *

Student Gender *

Male

Female

Student's Leader Role at Project Spirit e.g. Media, Station Leader, LIT, etc. (all Gr. 11s are LITs): *

Parent/Guardian Name: *

Parent/Guardian Email Address: *

Home Phone Number *

Parent/Guardian Cell Phone Number: *

Alternate contact person to notify if parent/guardian is unavailable and contact person's phone number: *

T-Shirt Size (adult men's sizes) *

Is your son/daughter allergic to any medications/drugs ? *

Yes

If you answered yes to the above question , please provide details.

Must your son/daughter continually receive any medication? *

Yes

If you answered yes to the above question , please provide details. (i.e. name of medication, detailed instructions on dosage, etc.)

Does your son/daughter have any allergies? *

Yes

If you answered yes to the above question , please provide details.

Must your son/daughter maintain a special diet? *

Yes

Please identify any dietary restrictions.

Please list Student's Ontario Health Card Number: (Optional - if not provided, student must bring their Health Card Number with them to camp)

Family Doctor's Name and Phone Number: *

Please provide any additional information which you feel we should know about your child. *

N/A

Physical Injury

Mental Health Concerns

Religious Observances

Social Issues

Other

Required

Please provide details re: additional information.

Please join the Camper Remind group so that you can receive reminders, info and updates. Click on this link: https://www.remind.com/join/pslead2019 (If you are a Rogers subscriber, you will need to download the app to get text messages.) *

I joined!!

I could not figure it out - please contact me to get me connected.

I do not want to join at this time

I give permission for my son/daughter to attend the above activity. *

Yes

FINALIZE THE REGISTRATION!!! *

Make the payment on School cash online (or bring cash to SWC)

Print, complete, and return the "Informed Consent - High Risk" Permission Form - it can be found on the SWC website, under the Project Spirit link in "Events".

Required

Note:

Personal information on this form is collected under the authority of the "Education Act, R.S.O., 1980, Chapter 129" and will be used to determine student attendance on extended field trips. Questions about this collection of personal information should be directed to the Principal of the school.

A copy of your responses will be emailed to the address you provided.

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