Hello everybody, come join us at the CISV
Fall Mini-Camp, 2008
Camp dates: Oct 17th (6:30 p.m) – Oct 19th (1:00 p.m)
Who: You! Anyone 10 years or older, who is ready for an awesome weekend jammed packed with a whole lot of fun.
Where: StevensonŐs ChildrenŐs Camp –5081 Gore road East - South Side – Approx. 2 KM East of Airport Road. North of Dorchester.
All new Activities and fun!
Bring a friend! Please read carefully and fully fill out all forms. Camp fee is $60.00. Fees include all meals and housing. Membership required. If you have attended one CISV camp and have not been a member, you will need to become one to attend another camp. Trial memberships will be given to first time attendees at no charge.
WHAT: CISV, or ChildrenŐs International Summer Villages, is a non-profit; youth focused organization that promotes peace and understanding through cross-cultural friendship. CISV participants learn about peace and related material through experience, discussion and exchange. This camp aims to show the participants a brief glimpse into the activities of a CISV international camp. This experience will also help prepare the people who are getting ready to go away this coming winter or summer. Throughout camp there is a balance of physical activities, thought- provoking activities and simulations. As a participant, you must be prepared to do some thinking and discussing on a wide variety of topics from racism to honesty to communication. NOW letŐs put our ideas together and make this camp an amazing one!
To find out more about CISV, check out www.cisv.org
To find out more about CISV Canada, check out www.cisv.ca
What to Bring:
Sleeping bag and pillow
Clothing for all weather (nights can be chilly)
Hygiene essentials
Running shoes
A snack for 10 people
A FRIEND!
CISV FALL MINI-CAMP FORMS
PLEASE NOTE THAT ALL FORMS ARE
DUE NO LATER THAN October 12th, 2008
NO forms will be accepted at the site.
Please read carefully and fully fill out all forms. Camp fee is $60.00.
Fee includes all meals and housing.
CISV JB London Fall Mini-Camp 2008
Stevenson Children's Camp
5081 Gore Road
Friday, Oct 17, 2008 (6:30pm) - Sunday, Oct 19, 2008 (1:00pm)
Contact Information:
Name:_____________________________ Age: ___ Gender: ______
Address: __________________________________
City:London____________CISV member of this chapter: _________________
Postal Code: ________ Phone Number: __(__)________________
E-mail address(es)____________________________________________________
I wish to be informed about JB events through this email address: ______________________J
I wish to have my email address added to the CISV London Email lists: _________________J
Medical Information:
Health Card Number:
Medical Information (Will you be taking any medication at camp? Allergies? Other Info?) ______________________________________________________________
__________________________________________________________________
____________________________________________________________________
Dietary Information: (Vegetarian? Vegan? Lactose Intolerant? Other info?)
__________________________________________________________________
____________________________________________________________________
Emergency Contact Name: _____________________________
Emergency Contact Phone Number: _(__519)_________________
Parent/Guardian Name(s): __________________________________________________
Parent/Guardian Phone Number(s):___________________________________________
Participation Form:
Participants please fill this section and sign it.
I, ___________________________, have read through and completed this application to the best of my ability. I wish to participate in this CISV camp, and I understand the purpose of a CISV camp. I understand that drugs (including non-prescription drugs and alcohol), weapons, violent behavior, and sex are STRICTLY prohibited at CISV activities. I will do my part to make this camp the best it can possibly be. I realize that if I break the rules I could be sent home immediately at my own expense.
Signature of Participant: ________________________ Date: ____________________
Cabin Leaders
Would you like to be a cabin leader? Yes _?? No _??
Cabin leaders must be 15 years of age or older.
Cabin leaders are responsible for a group of kids that you share a room with, reporting any issues and letting an adult know where you are.
CISV Canada Mini-Camp/Activity Waiver
Please, if you are 18 or over complete and sign or if you are under 18 please have your parent/legal guardian complete and sign this form.
I/we, ________________________________________________, (parent/legal guardian) of __________________________________________________ (CISV participant) hereby give permission for _______________________ to participate in the following CISV Activity:
I hereby release CISV and its volunteers from any financial or legal cause of action arising through sickness of accident, except by reason of gross negligence by CISV and/or its volunteers during the CISV activity.
A CISV participant is expected to conduct her/himself at all times in conformance with local laws and CISV rules (INFO FILE R-7). Participants engaging in inappropriate behavior may be sent home before the end of the activity at CISVŐs discretion and without CISV financial liability.
I have been informed about the CISV insurance rule and understand that it is my responsibility to provide adequate health and accident insurance for the above participant during the CISV program. I also understand that all travel arrangements to and from the CISV activity and appropriate cancellation insurance are our own responsibility consistent with CISV National/Chapter rules.
As proof of my consent in granting permission for _____________________ to participate, I have signed this document on the following date: __________________________________
Signature: ____________________________________ (of Parent or Legal Guardian)
Signature: ____________________________________ (of CISV participant)
I give my permission for my childŐs photograph to be taken and used solely in CISV promotions.
I am aware of the registration deadline and I understand that no forms will be accepted at the site.
I give permission for my son/daughter to participate in the high ropes course on site. I am aware that this is considered a high risk activity. The high ropes course will be lead by trained instructors.
Signature: _____________________________________ (of Parent or Legal Guardian)
Please send the Completed Form and CHEQUE (made out to CISV JB London)
Contact Coordinator:
Emily Putherbough
166 Whiteacres Dr
London, Ontario
N6G 4N2
Phone #: (519) 657-9837
Email:[email protected]