registration form

Personal Informaon
Last Name:
First Name:
Please Circle: Parcipant / Service Team
Street Address:
City:
Postal Code:
Gender (Circle): Male /
Province:
Home Phone:
Female
Date of Birth (Month/Day/Year):
Cell:
Email Address:
/
/
School:
Household Servant (Members only):
Chapter (Members only):
Emergency Contact Informaon
Name of Parent/Guardian:
CFCFFL Member: Yes / No
Parent’s Email Address:
Contact Number:
Family Doctor:
Family Doctor’s Contact Number:
Allergies / Health Issues or Medical Informaon:
(please list medicaon taken)
Health Card:_______________________
Waiver of Liability
I, the undersigned parent/legal guardian, whose name appears on the registraon informaon, herby give consent to my son/
daughter whose name appears on the registraon informaon, to a0end and/or serve in the YFL Camp Unity on Friday, September 12, 2014 to Sunday, September 14, 2014. I, the undersigned, fully acknowledge that signing the foregoing release absolves
and relieves CFCYFL from any responsibility and/or liability while engaged in the acvies within the scope of this event. I agree
and understand the condions of this event, and do not hold CFCYFL liable for any costs and damages to any property that may
be caused by the parcipaon in the event.
Name of Child / Parcipant: __________________________
Name of Parent / Guardian: _____________________________
Signature of Parent / Guardian: ______________________________
Date: ________________________
Parent Contact Informaon:
Mississauga/Hamilton/Brampton
Jun and Nane0e Custodio (905) 864 - 0218
Toronto Central
Nelson and Joyce Yee (416) 729 - 2637
Toronto East
Pat and Fe Alba (416) 648-7726
Things to Bring: Sleeping bag, pillow, bible, paper and pen, toiletries, shower slippers, snacks,
epipen (if needed), health card, extra comfortable clothes.
Locaon
Countryside Camp
1985 Beke Rd RR 4
Cambridge, ON
N1R 5S5
YFL Cluster Servant Contact Informaon
Jovin Ribo
647-200-3818
Krisne Sabido 647-216-2987
Luiz De Guia
647-982-3253
Serriz Peña
647-216-2987
Blesy Gallardo 647-457-0604
Marn Yee
647-231-1642
Alex Custodio
647-884-8997
James Asuncion 289-244-6385

Download Report