Online Registration

Student Information:

First Name:

Middle Name:

Last Name:

Mailing Address:

City:

Province:

Postal Code:

Home Phone:

Cell Phone:

Email Address:

Date of Birth:

First Nations Band: (if applicable)

Health Card #:

Does the student have any known allergies, chronic illness, or medical conditions?

Note: a medical waiver will be required by the candidate selected to attend the camp.

If yes, please describe:

Gender:

Male
Female

Aboriginal Descent:

Status Indian
Non-Status Indian
Metis
Inuit

High School Information:

Name of Highschool:

Grade:

Mailing Address:

City:

Province:

Postal Code:

School Phone:

School Fax:

Parent/Guardian Information:

First Name:

Middle Name(s):

Last Name:

Mailing Address:

City/Town:

Province:

Postal Code:

Home Phone:

Cell Phone:

Work Phone:

Parent/Guardian must sign a release form upon youth participants arrival.

Emergency Contact:

Name:

Relationship:

Phone:

Name:

Relationship:

Phone:

Optional Question

To ensure all youth participants recieve AYEC swag, please select Jacket and T-Shirt Size (all clothing will be ordered in Adult sizes)

Jacket S M L XL 2XL 3XL

T-Shirt S M L XL 2XL 3XL

What are your goals for the future, and how do you think this camp will contribute to you achieving those goals?