Application English in Canada - Destination Canada International Summer Language Camp 2006 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				send application & two photos to Lisbeth Graverholt
Family Name	First Name			Sex: Date of birth Age on July 1, 2006:
Address	City			Postal Code
Telephone	Home fax			E-Mail
Citizenship	Passport Number			Place of Birth
Mother’s Name	Occupation			Business Phone
Father’s Name	Occupation			Business Phone
Name and address of home school				Phone
Has participant lived in a foreign country Where?				Yes ___ No ___	How long?
Does participant suffer from medical problems? Is medical treatment required? (Please attach explanation if necessary)				Yes ___	No ___
List languages applicant speaks
Registering for the following session: 3 weeks ___ 4 weeks ___			Niagara Falls Tour: Yes ___		No ___
Provide complete flight schedule to Ottawa Airport. Date and time of all flights connections (may be submitted at a later date)
Signature of parent/guardian Date (With the signed application form you accept the conditions about payment as outlined in “Praktiske oplysninger 2006”)
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 parent, 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