Slide 1

Report
CCS & FES
March Break
K-5
Enrichment Camp
March 6-8 , 2012
Centreville Community & Florenceville Elementary In
partnership with the Carleton Victoria Community Inclusion
Network, supported by the NB Economic and Social Inclusion
Network.
Registration Form
Camper’s Name:_______________ Age:____ Date of Birth_________
Accompanying adult_____________________________ Relationship to student _____________
Parent/Guardian:_______________ Phone: (H)________(W)________
Address:______________________________________________
Emergency Contact:____________ Phone:_________
Medications:___________________________________________
Allergies:______________________________________________
Additional Information:____________________________________
Release of liability: As a condition of my child’s participation in the Enrichment Camp, I agree to release District 14,
its employees and agents and any and all liability for any bodily injury, property damage, death or loss of any nature
and kind that may occur from participation in any activities of the Enrichment Camp.
I also agree to have my child’s name and any pictures taken at the camp used for publicity purposes should the need
arise.
Signature of parent or guardian:_________________ Date:________
Registration deadline: February 24 with Valerie Carmichael, Community School Coordinator, CCS
and FES by calling 276-4015 or email [email protected]

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