Personal Contact Information - Asterisk (*) Indicates required field

*City:

*Postal Code:

*Province:

Province Ontario Quebec Other Other:

*Home Phone:

Cell Phone:

*Email:

MSN:

Emergency Contact Information - Asterisk (*) Indicates required field

⁽²⁾ Please do not enter someone who is also going to the camp.

Additional Information Asterisk (*) Indicates required field

*Age as of Sept 2, 2011: 

*Date of Birth (YY/MM/DD): 

Gender Male Female

*Status: 

Status Single Married

If you have relatives/family members in the camp this year, please provide their names separated by , : 

*Special Medical Condition / Food Allergy / Food Restrictions: 

Please Remember to bring your health card to the camp!!!

Are you a Catholic: 

YesNo

please state your parish or / and CCC:  

please provide your religious background: 

*Which Post-Secondary Institution will you be attending in September 2011: 

Select Institution None College, please specify Carleton University Concordia University McGill University McMaster University Queens University Ryerson University University of Ottawa University of Toronto University of Waterloo University of Western Ontario York University Other, please specify:      Other:

*Payment Method: 
(Note: We do NOT accept credit card)

 Cash   Cheque
(Cheque Recommended)

Please remember to write down your registration ID # with your payment, which will given to you after you submit this form.

Cheque payable to "Eastern Canada Chinese Catholic Living Camp".

Early Bird Ended
Regular Price: First-time Campers: $190, Returning Campers: $195
All registration ends on the August 21st.
Please make your payment before the deadlines.

Camp Information Asterisk (*) Indicates required field

*Which language do you prefer for sharing: 

Language Cantonese Mandarin English

Can you do sharing in: 

Yes No to Cantonese
Yes No to English
Yes No to Mandarin

Do you understand Cantonese? 

*Do you agree to have the following items 
be published in the ECCCLC handbook: 
(check all that apply) 

Email address
Phone(please specify)
  

How many times have you been to ECCCLC: 

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26+
Referred By:

If this is your first time

*T-shirt size preference:

*Bus Boarding Location: 

Downtown Toronto/OLMC
Markham/CMCC
Mississauga/SOTW
Richmond Hill/SATCC
Montreal/MCCM
Ottawa/Sheng Shen

Shower Time Preference: 

Morning
Evening

Please check out ECCCLC website after August 15th, 2011 for bus boarding time, locations, and items that you are responsible to bring to the camp.

OLMC - Our Lady of Mount Carmel Church
CMCC - Chinese Martyrs Catholic Church
SOTW - Saviour of the World Chinese Catholic Church
SATCC - St. Agnes Kouying Tsao Catholic Church
MCCM - Montreal Chinese Catholic Mission
Sheng Shen - Élise Catholique Sheng Shen Catholic Church

Are you interested in helping out in these areas?

Singing Team:

Singing

Liturgy Team:

Reader

Altar Server

Audio and Video Team:

Photography

Videographer

Setup Team: 

Setup

Translator/Interpreter:

Cantonese to
     English

Cantonese to
     Mandarin

English to
     Mandarin

Group:

Group Leader

Others:

First Aid

Security

Disclaimer

I,  hereby release and forever discharge, all volunteers, all parishes and any other individuals and/or groups involved with the 35^th Eastern Canada Chinese Catholic Living Camp (ECCCLC) 2011, from any and all actions, causes of actions, claims and demands whatsoever whether existing as of this date or in the future and whether arising from the participation of ECCCLC 2011 or otherwise.

In the event of illness or injury, my emergency contact will be notified immediately. In case of surgical emergency, I hereby give permission to the physician selected by the camp to hospitalize, secure proper treatment and to order injections, anesthesia or surgery.

By pressing the Submit button below, I acknowledge that I fully understand all provisions of the above agreement.

Please Click ONCE only

Note: Any participant under 18 years of age must have the consent from parents / guardian.

Submission of this electronic application form will only hold a space for you, providing that appropriate registration fee is paid in full to local rep before August 21st, 2011. If you failed to submit the appropriate registration fee before August 21st, 2011, your place will be deferred to another applicant. Your spaces will only be guaranteed when registration fee is received in FULL by local representative(s).