Encounters With Canada CBRG and Gladstone Secondary Application

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First Name *

Last Name *

email *

I am a student

who volunteers or have volunteered at Camosun Bog, Pacific Spirit Park or Catching the Spirit

who attends or has attended Gladstone Secondary School

who is an artist who draws MANGA or FELT PEN or PENCIL and any media for sketching

Clear selection

My age on June 26, 2017 to July 3, 2017

18 or over. We are sorry, the funding for this program is only available to those who are 17 and under on the days of the excursion

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What are your reasons for attending Encounters with Canada? Explain why you would be a good candidate to represent your school in Ottawa and what you hope to gain from this experience.

Have you ever been on a camp lasting 3 to 5 days or more with other youth? What behavioural expectations do you think would be expected in a camp like this? Name a few and comment on your ability to follow them

Provide the name and email of a principal or vice principal so I may contact them regarding your readiness for such a program

provide the name and email of a counsellor who has known you for at least two years so I may contact that individual with regards to your readiness for Encounters With Canada

provide the name and email of a teacher at your school who will recommend you so I may contact that individual with regards to your participation in this program

The fee for Encounters with Canada will be between $600 to $675 depending on our group size. Please answer the following

I am able to raise this amount, pay a 15% deposit by October 15, 2016

This amount is a challenge to me. I need to raise funds but I can pay the deposit and raise the funds by December 2016

This amount is a great challenge and I will need to raise funds.

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Please have the parent or guardian fill out the form: Parent or guardian full name:

I certify that I am the parent or guardian of (write student name)

I allow my child to attend the Encounters With Canada program as it is described in this website https://www.ewc-rdc.ca/pub/en/node/955

yes

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I agree that my child can abide by the Vancouver School District and West Vancouver School district drug and alcohol policy as outlined here: "No student may be in possession of or under the influence of illegal or non-prescribed drugs or alcohol in the school, in the vicinity of the school, or at school sponsored functions. Any infraction will be considered serious and will result in the immediate implementation of school and Board policies dealing with student discipline. This may include possible suspension, withdrawal and transfer of the students involved." http://go.vsb.bc.ca/schools/gladstone/About/Pages/School-Policies.aspx

yes

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If my child does not follow school policy for behaviour on overnight field trips, then he or she can be sent home at the parent's expense

I agree

I do not agree

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I understand that the students will be staying at the Terry Fox Centre where there will be a separate girls and boys sleeping area. My child will abide by the rules that state that they are to stay in their own designated area at night

I agree

I do not agree

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Parent or guardian can attend a mandatory info night at Gladstone Secondary to learn more about this program and go over expectations on September 29 5:30 to 6:30 pm Room C202 *

yes

I grant permission for my child to attend this field trip and will fill out any necessary permission forms provided by the school *

I agree

I do not agree

Parent or guardian full name *

Parent or guardian email *

Parent or guardian phone number *

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