Day Visit Registration Form Web Site Personal Information First Name * Last Name * Address * Postal Code * City * Province * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Home Phone * Cell Phone Personal Email * Emergency Contact Information Please do not name someone who is also attending the camp this year. Emergency Contact * Contact Number * Relationship * Additional Information Date of Birth * Gender * Male Female Medical Conditions/Food Allergies/Restrictions * Catholic * Yes No Other University/Alma mater Carleton University McGill University McMaster University Queen's University Ryerson University University of Ontario Institute of Technology University of Ottawa University of Toronto University of Waterloo University of Western Ontario York University Concordia University University of Montreal Other CCC LCCC MCCC UTCCC WCCC Other Camp Information Preferred Language * English Cantonese Mandarin French Translation Required? English --> Cantonese English --> Mandarin English --> French Cantonese <--> Mandarin None I am fluent in English Cantonese Mandarin French Number of Times at ECCCLC * 0 1 2 3 4 5 6 7 8 9 10+ T-Shirt Size * S M L XL Preferred Bus Location * Downtown Toronto (Our Lady of Mount Carmel Church, OLMC) Markham (Chinese Martyrs Catholic Church, CMCC) Mississauga (Saviour of the World Chinese Catholic Church, SOTWCC) Richmond Hill (St. Agnes Kouying Tsao Catholic Church, SATCC) Montreal (Montreal Chinese Catholic Mission, MCCM) Ottawa (Eglise Catholique Sheng Shen Catholic Church, SSCC) N/A (driving) Other (please contact your parish rep/GT Community Connections) You're coming for a day visit, yay! Please note that you will be responsible for your own transportation TO and FROM the camp. Address of campsite: Camp Kahquah, 1230A Nipissing Rd S, Magnetawan, ON P0A 1P0 When are you arriving to the camp? Please indicate the date and time. * When are you leaving from the camp? Please indicate the date and time. * Which meals will you be staying for over your visit? Saturday, August 31 Meals Breakfast Lunch Dinner Sunday, September 1 Meals Breakfast Lunch Dinner Monday, September 2 Meals Breakfast Lunch Waiver **Please note that participants under the age of 18 must fill in a paper waiver and return to any ECCCLC representative OR sign, scan, and email a digital waiver to email@example.com. A digital copy of the waiver can be found here. RELEASE OF LIABILITY, WAIVER OF CLAIMS ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT By signing this document you will waive certain legal rights, including the right to sue. AWARENESS AND ASSUMPTION OF RISK I am aware that participating in this camp held by ECCCLC involves risks including risk of personal injury, death, property damage, expense and related loss, including loss of income. Included in these risks are negligence on the part of ECCCLC, Inc., its directors, officers, officials and volunteers, other participants and owners of the facilities where the activities occur (referred to in the rest of this agreement as “ECCCLC, Inc. AND OTHERS”). I freely accept and fully assume all such risks and the possibility of personal injury, death, property damage, expense and related loss, including loss of income. RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT In consideration of ECCCLC, Inc. accepting my application to participate in this activity, I agree: To waive any and all claims that I may have in future against ECCCLC, Inc. AND OTHERS. To release the ECCCLC, Inc. AND OTHERS from any and all liability for any personal injury, death, property damage, expense and related loss, including loss of income that I or my next of kin may suer as a result of my participation in this activity, due to any cause whatsoever, including negligence, breach of contract or breach of any statutory duty of care. To hold harmless and indemnify ECCCLC, Inc. AND OTHERS from any and all liability for any damage to property of, or personal injury to, any third party, resulting from my participation in this activity. To grant permission and consent to allow for photos to be taken during camp session activities. I further give permission and consent that any such photographs may be published and used by ECCCLC, Inc. AND OTHERS, to illustrate and promote the camp experience, ECCCLC and its programs. That this agreement is binding on not only myself but my next of kin, heirs, executors, administrators and assigns. I HAVE READ THIS AGREEMENT AND UNDERSTAND IT. I AM AWARE THAT BY SIGNING THIS DOCUMENT I AM WAIVING CERTAIN RIGHTS WHICH I OR MY NEXT OF KIN, HEIRS, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE AGAINST ECCCLC, Inc. AND OTHERS. Permission * Yes, I agree to these terms. Comments Payment Options CHEQUE: Please write a cheque payable to "Eastern Canada Chinese Catholic Living Camp" and include the attending camper's full name in the memo/notes. E-TRANSFER: Please send to firstname.lastname@example.org, and include the attending camper's full name in the message. Any other things you would like us to know? If not, just hit that submit button below. We'll be looking forward to seeing you this year at GT 2019!