Personal Information
Name: ________________________________________________________________________
Address: ________________________________________________________________________________________________________________________________________________
Parent/Guardians Names (if under 18): ____________________________________________________________________
Phone numbers: Home: ___________________________________
Work: ___________________________________
Email address (participant)
_____________________________________________
Name of chaperone (if under 16) One chaperone is required for every 5 students from a community.
______________________________________________
Phone number: _______________________________
Alternate Contact
Name: ________________________________________________________________________
Phone numbers: Home: ____________________________________
Work: ___________________________________
Email address: (optional) ___________________________________________
If under 18:
Date of Birth: ____________________ Grade entering in the Fall: ________
Health Information
NWT Health Card Number: ___________________________________________
Do you have any health conditions/special requirements that the camp organizers should be aware of?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________________________________________________________________________________
Are you taking any medications that the camp organizers should be aware of? If yes, please list.
________________________________________________________________________
________________________________________________________________________________________________________________________________________________
Do you have any allergies? Please list.
________________________________________________________________________
________________________________________________________________________________________________________________________________________________
Although the risk of camp related injuries is low, they may occur on occasion. In the event of a serious injury, you or your child may have to be brought to the Hay River hospital or to the Yellowknife hospital for treatment. Your signature below, which constitutes consent for medical treatment for you or your child (in case of unexpected illness or injury), will ensure that you or your child will get prompt medical attention should we not be able to contact parents/guardians personally. Your signature also waives any and all liability from volunteers for personal injury or accident to you or your child while attending our fiddle camp.
Signature: ___________________________________________ Date: ____________
(Parent or Guardian if under 18)
Fiddling Experience
Number of years fiddling: ________
How long have you had lessons or instruction? ________________________________________________________________________
Have you been to a fiddle camp before: YES NO (circle one)
If yes, which ones? ________________________________________________________________________
________________________________________________________________________
Do you have your own fiddle, or a fiddle that you can bring to camp? YES NO (circle one)
Do you belong to a Kole Crook Fiddle Association or Strings Across the Sky community group? YES NO (circle one)
Please check the category that best describes your ability to learn by ear:
____ Beginner (no experience)
____ Intermediate (a little experience)
____ Advanced (experienced)
Accommodation
Accommodation is limited at our camp this year. The Chief Sunrise school gym is available for students with their chaperones. If you live in Hay River,
you will be going home each night. If you are coming from out of town and have contacts in Hay River, please look into staying with them. If you have
a camper, the Hay River reserve will offer parking space and a portable toilet. However, campers must be self-sufficient as there will not be electrical
hook ups or water. There is, however, a general store within walking distance to purchase anything you might need.
There are also a number of hotels in Hay River. Please contact Andrea Bettger if you need assistance with accommodation.
Please check one of the following:
I will be staying in the Chief Sunrise school gym: _____
I will be staying with friends/relatives in Hay River: _____
Name of family: ___________________________ Phone number: ________________
I will be staying in a camper on site: _____
Hay River residents: (optional)
I would be interested in accommodating ____ (number) of participants in my home.
T – shirt size (please circle)
Youth: S M L XL
(youth sizes are extremely small...most children 10 and older wear adult sizes)
Adult: S M L XL
Permission Slip
(if participant is under 18)
I, ___________________________________, hereby give permission for __________________________________
to attend the Kole Crook Fiddle Camp taking place on the Hay River reserve from July 7th- 11th, 2008.
Signed: ____________________________________________________
Relationship to participant: ____________________________________
Chaperones
Chaperones are an extremely important part of our camp to ensure that students are supervised at all times. Chaperones are expected to be actively
involved in all areas of the camp (attend lessons, meals, recreation time, evening activities). Chaperones do not have to pay to come to the camp.
If you are coming to our camp as a chaperone, please indicate which students you are chaperoning:
________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________
________________________________________________________________________
FEES
(for administrative use only)
Personal Cheque# __________ or money order ___________
__________ Amount received _____________ Date received
__________ Receipt sent _____________ Balance owed
Thank You!
