Application
English in Canada - Destination Canada
International Summer Language  Camp
at
Carleton University in Ottawa
Fax or Mail to:  Lisbeth Graverholt    
         English in Canada, Hjørring Gymnasium, 9800 Hjørring
Phone & Fax: 98911425
lisbeth.graverholt@skolekom.dk

FAX or Mail
applicaiton

&
2 photos & original application to Lisbeth Graverholt
Family name

First name

Age by July 1

Sex:  
Birth date (day/month/year)
              
Address City Postal code
Home Phone Home Fax

e-mail

Citizenship Passport Number

Place of Birth
Mother's Name Occupation

Bus. Phone

Father's Name

Occupation

Bus. Phone

Has participant lived in a foreign country?
Where?
yes ___     
no ___
How long?
Does participant suffer from medical problems? Medical treatment required?

Yes ___
Please attach explanation.
No ___
List languages applicant speaks    

Name and address of home school

 

Phone

e-mail

Name of home school Principal/Director

Name of English teacher:

E-mail:
.
E-mail:
Registering for the following session:  3 weeks ___      
                                                                          4 weeks ___
Niagara Falls Tour
Yes ___
No __
Provide complete flight schedule to Ottawa Airport (may be submitted at a later date)  Date and time of all flights  

 

 

For Guardians
Permission - In enrolling my child I hereby agree to permit the camp doctor or nurse to administer such routine medication as they deem advisable in the event of an emergency. If camp doctors are not able to contact either parents, the directors are hereby given permission to act on the parent's behalf in signing permission for medical care as advised by a medical doctor.
Signature of Parent/Guardian Date                     
Signature of Parent / Guardian Date