Leadership CIT 2024

Along with this application please submit two references and a letter explaining why you would like to be part of our CIT program to our email campmonahan@sasktel.net. We will be contacting you for an interview after the receipt of your application.

Last Name*

First Name*

Middle Name

Gender*

MaleFemale

City*

Address*

Province*

Postal Code*

Birth Date (Must be 16 years or older by December)*

MonthDayYear

Grade entering in the fall*

Parent/Legal Guardian*

Relation*

Phone 1*

Area CodePhone Number

Phone 2

Area CodePhone Number

Parent /Legal Guardian 2

Relation 2

Work Phone 2

Area CodePhone Number

Cell Phone 2

Area CodePhone Number

Home Phone

Area CodePhone Number

Emergency Contact Name(if parent or guardian is not avaliable)*

Emergency Number*

Area CodePhone Number

Emergency Number #2

Area CodePhone Number

Are there any custody issues? Please provide any pertinent details.

Parents Email (camper confirmation will be sent by email)

Camp Monahan periodically sends out updates and Newsletters.

Yes, subscribe me to this newsletter.

Hospitalization #

Family Physician

YesNo

Does your child have any physical, behavioural or other conditions that require special attention while at camp?If yes, describe your child's needs.

Does your camper require medication at camp?

YesNo

List all medications, both prescribed and over the counter. All medications will be turned into the health officer except rescue inhalers. Bring all medication in original containers.

Does your child have any allergies?

YesNo

List any allergies (ex: bees,peanuts, dairy)

Any dietary needs that we should know about? Please contact our office if an alternate menu is required.

I understand that if there are any changes to the medical information provided in this registration/or if my child has medication to be dropped off at the time of arrival, I/we will inform the camp on drop-off day. I am of the belief that my child is in good health and able to participate in the camp experience. I also agree that if necessary, basic First Aid (which could includes icing, minor wound/burn care, bandages) and medication (which could include: acetaminophen, ibuprofen, anti-diarrheal, antihistamine, dimenhydrinate (Gravol), antacids, antibacterial ointment, cough drops, eye/ear drops) can be administered as needed while at camp; I give my approval for transportation to and from a doctor’s office or hospital if deemed necessary.

Campers exhibiting cold and flu symptoms are encouraged to contact the camp office to determine their wellness to attend camp. This is to ensure the health and safety of our staff and other campers. If a camper is unable to attend our office will work with you to determine an appropriate solution.

Medical Waiver

Agree

I agree that photos of my child can be taken and used for camp promotions including social media purposes*

YesNo

By hitting submit and putting your initials, you agree that you are the parent or legal guardian of the above named camper, and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel. I understand that the above named camper will only be released to the names listed above, an update may be done at registration. I certify that my child has my permission to attend camp and participate in all activites.

Electronic signature, please initials*

Camp Monahan LEADERSHIP / CIT Application

Parent or Legal Guardian Information

Emergency Contact Info

Email Confirmation

Health Information

Medical Waiver

Photo release