CRC Youth Program Registration

Program Selection(required) GAME ON! Barry's Bay GAME ON! Combermere GAME ON! Killaloe GAME ON! Palmer Rapids Explorers Summer Day Camp Killaloe Explorers Summer Day Camp Palmer Rapids Explorers Summer Day Camp Killaloe Jr Explorers Summer Day Camp Madawaska & Whitney Explorers Summer Day Camp Madawaska Only Explorers Summer Day Camp Whitney Only Girls Rising Empowerment Program Killaloe Stay Wild Girls Summer Experience

Participant Name(required)

School/Home School

Home-Schooled?

Address(required)

Town(required)

Postal Code(required)

Home Phone(required)

Date of Birth (m/d/y)(required)

Age(required)

Grade(required)

ANY CONCERNS OR HEALTH PROBLEMS STAFF NEED TO KNOW ABOUT (i.e. inhalers, Epi Pen, etc.)

DIETARY RESTRICTIONS (i.e. Food Allergies, Gluten or Dairy Free, etc.)

I am aware that I must complete a program waiver prior to my child participating in any CRC youth program and will do so at or before the fist day of Summer Camp.(required) Yes