PE 10 registration
Acceptance to the program will be granted on a first come, first serve basis. Minimum of 12 students per week, maximum of 20 students per week. Students must not have already received high school credit for CALM. You will need your child's health care number as well as Alberta Student Number (ASN) in order to complete this form. You can get the ASN through mypass.ca if you are registered, or through your child's school. You will also need his/ her Alberta Health number
Select your first choice week *
Does your child know anyone else in the program? Provide names here:
Your answer
Select your second choice week *
Student's First Name *
Your answer
Last name *
Your answer
Street Address *
Your answer
Town/ City *
Your answer
Province *
Your answer
Postal Code *
Your answer
Student's Phone Number *
Your answer
Alberta Health Care Number *
Your answer
Student's age as of July 1, 2018 *
Your answer
Birth Date *
MM
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DD
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YYYY
Last year of school successfully completed *
Your answer
Alberta Education # *
Your answer
Male/ Female *
Mother's first name *
Your answer
Mother's last name *
Your answer
Mother's home phone number *
Your answer
Mother's work phone number *
Your answer
Father's first name *
Your answer
Father's last name *
Your answer
Father's home phone number *
Your answer
Father's work phone number *
Your answer
Who has legal custody of this student? *
Contact Email for communication from GYPSD and the Palisades *
Your answer
Emergency Contact Name *
Your answer
Emergency contact home phone number *
Your answer
Emergency contact work phone number *
Your answer
Briefly summarize any extended outdoor experiences the student has had: *
Your answer
Can the student run 3 km in under 30 min? *
Can the student swim 100m comfortably? *
For the purpose of fitting equipment, what is the student's height? *
Your answer
Student's weight? *
Shoe size *
Your answer
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