THE YES: Application

Thanks for signing up!

We can't wait to see you!

PARTICIPANT INFORMATION

First name:

* Required

Last name:

* Required

Gender:

* Required;

BC Care Card #

* Required

Address

* Required;

City

* Required;

Province

* Required;

Postal Code:

* Required;

Home Phone:

( )

* Required;

E-mail:
Note: Please enter a valid email, as a confirmation with important attachments will be sent to you.

* Required

Date of Birth (YYYY-MM-DD):

* Required;

Health/Dietary restrictions (dietary needs, vegetarian, allergies: be specific about condition and severity):

* Required;

Emergency contact name:

* Required;

Relationship:

* Required;

Telephone 1:

( )

* Required;

Telephone 2:

( )

Name of Parent/Guardian:

* Required if under 18 years of age

Telephone 1:

( )

* Required;

Telephone 2:

( )

Address if different from above:

CAMP AND TRANSPORT INFORMATION

Camp Attending:

Transportation:

* Required;

Have own transportation to and from camp

Have own transportation to camp AND require bus transportation from camp
Drop-off location:

Have own transportation from camp AND require bus transportation to camp
Pick-up location:

Require bus transportation to and from camp
Pick-up location:
Drop-off location:

Additional Transportation
Details:

Please indicate if you are interested in offering or receiving carpooling from your area.

PAYMENT INFORMATION

We now accept PayPal for payments! Payment with Paypal is available on the next page, once you hit 'submit'.

Early Bird Price: $350.00 before February 19th
Regular Price: $375.00 after February 19th
Early Bird Student Price: $300.00 before February 19th
Regular Student Price: $325.00 after February 19th

Cheque

Sponsorship:

Sponsor 1:
Amount:		$
Sponsor 2:
Amount:		$
Other sponsor:
Amount:		$

I'm still looking for sponsorship

Please indicate if you are able to offer an additional amount to subsidize a youth participant:

OTHER INFORMATION

If you have any other information, concerns or questions relating to your application please include them here. Also, let us know how you heard about The YES and what you think of the website and look, any and all feedback is welcome.

PLEASE NOTE! Once you hit the submit button, it will take a few seconds to load the next page. Please do not refresh or navigate away from this page! Please let the page load fully before going elsewhere on the website.