CCS & FES March Break K-5 Enrichment Camp March 6-8 , 2012 Centreville Community & Florenceville Elementary In partnership with the Carleton Victoria Community Inclusion Network, supported by the NB Economic and Social Inclusion Network. Registration Form Camper’s Name:_______________ Age:____ Date of Birth_________ Accompanying adult_____________________________ Relationship to student _____________ Parent/Guardian:_______________ Phone: (H)________(W)________ Address:______________________________________________ Emergency Contact:____________ Phone:_________ Medications:___________________________________________ Allergies:______________________________________________ Additional Information:____________________________________ Release of liability: As a condition of my child’s participation in the Enrichment Camp, I agree to release District 14, its employees and agents and any and all liability for any bodily injury, property damage, death or loss of any nature and kind that may occur from participation in any activities of the Enrichment Camp. I also agree to have my child’s name and any pictures taken at the camp used for publicity purposes should the need arise. Signature of parent or guardian:_________________ Date:________ Registration deadline: February 24 with Valerie Carmichael, Community School Coordinator, CCS and FES by calling 276-4015 or email valerie.carmichael@nbed.nb.ca