Last Name
male female Street Address
City
Province Alberta British Columbia Manitoba New Brunswick Newfoundlan & Labrador Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Northwest Territories Nunavut Yukon
Phone
Health Card Number
Parents/Guardians
Check all that apply: Kids Camp Family Camp Teen Camp I would like to apply for financial assitance I DO NOT want any pictures of my child taken during camp to be used in promotion for HLBC. I will not hold anyone responsible for any injury or harm that may occur while I or my child participates in any of the activities at camp.