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: 

Gender Male Female

*Status: 

Status Single Married

*Special Medical Condition / Food Allergy / Food Restrictions: 

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

please state your parish or / and CCC:  

Day visitor must Arrange your own transportation.

*Where will you be leaving from:
(e.g. Markham, Montreal...)

*What day and time will you be leaving your home location (e.g. Sat 06:00am):

*What day and time will you be leaving the camp (e.g. Sun 08:00pm):

Are you the driver:

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

 Cash   Cheque

Please remember to write down your registration ID # (e.g. D1) with your payment, which will given to you after you submit this form.

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

Price: $50/day, staying over night is free. Second day count from breakfast. (If you are staying overnight please bring your own sleeping bag.)

All registration ends on the August 21st.
Please make your payment to the committees, Dennis Hau or Julia Tang, directly, before or at the camp..

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? 

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+

*T-shirt size preference:

Shower Time Preference: 

Morning
Evening

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

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