Qalipu 2018 Junior RNC Police Academy Camper Form

This Form is Required For Registration For Camp!
The Camper Form, below, must be completed and submitted online by July 20th.  Just fill out the information boxes below and click ‘send’.

We also ask that you print, sign and return the waiver found here: http://qalipu.ca/qalipu/wp-content/uploads/2018/07/JPA-Application-2018-002.pdf

Signed waivers can be faxed, emailed or sent to the following contact:

Megan Newman
Administrative Assistant | Community Development

Mail:
3 Church Street
Corner Brook, NL
A2H 2Z4

Email:
mnewman@qalipu.ca

Fax:
709-634-3997

Important Notes

All applicants must be between 9 and 12 years of age as of the camp date.

Campers who have not attended the RNC Camp before will be given first opportunity.

No visitors except in Cases of Emergency

Dress Code: inappropriate or revealing clothing (such as short skirts, belly tops, strapless and low cut shirts, pants dropping below the hip line and clothing with alcohol, drug or offensive language) will not be tolerated.

General Information

Name (required)
Telephone Number
Address
Email Address
Date of Birth
Gender  Male Female
School Grade
Are you a member of the Mi'kmaq First Nations or other minority group:
Please Specify (optional)
T-Shirt Size (Youth) S M L XL 


Surname-Parent/Guardian
Name (Mother)
Name (Father)
Telephone
Address
Family - number of people under 18 years at home
Number of children in school
IN CASE OF EMERGENCY PLEASE NOTIFY
Name
Address
Email Address
Telephone Number
Relationship to Camper

Medical Information

MCP #
List Operations and Injuries Giving Date and Nature
List Any Physical Disabilities That May Prevent Camper From Participating Fully in Camp Program
List All Medicines Which the Camper Must Use During Camp - Including Name of Drug(s), Condition Drug is Prescribed For and Dosage
Name & Telephone # of Family Doctor
Place Check Mark If Camper Suffered From Any of the Following and Indicate When
Chicken Pox Kidney Trouble Hyper Activity Arthritis Seizures Diabetes Fainting Bed Wetting Appendicitis Bronchitis Skin Disease Asthma Sleep Walking Eczema Boils Ear Trouble Hysteria Sinus Trouble Hay Fever Epilepsy Attention Deficit 

Are There Any Other Illness or Behavioural Issues Not Listed? Yes No 
If Yes, Please Provide a Complete List:

Does the Camper Have Any Allergies? Yes No 
If Yes, Please Provide a Complete List:

Does the Camper Require an Epipen? Yes No 
Does the Camper Have All of His/Her Immunizations Up to Date? Yes No 
Does your Child Need Constant Supervision? Yes No