2013 Leadership Camp Application Form - Royal Canadian Legion

SECTION 5 – Conduct A (Student Discipline Agreement)I acknowledge having read and agree to the rules of CONDUCT A for students provided by the Nova Scotia/NunavutCommand of the Royal Canadian Legion.Signature of Student:Date:Signature of Parent/Guardian:Date:SECTION 6 – Conduct B (Rules & Regulations for Students)I acknowledge having read and agree to the rules of Conduct B for students provided by the Nova Scotia/Nunavut Commandof the Royal Canadian Legion.Signature of Student:Date:Signature of Parent/Guardian:SECTION 7 – Medical CertificatePLEASE PRINT CLEARLYHealth Card #:Date:Expiry Date:Name of StudentLast: First: Middle:Home Address of Student:Phone Number:Date of Birth:Please list any serious illnesses, disabilities or limitations:Emergency Number:Gender: ⃝ Male ⃝ FemalePlease list any known allergies:Please list any medications:Do you wear eye glasses or contact lens? ⃝ Yes ⃝ NoEmergency Contact Name & Phone Number:Alternate Person to Contact:Signature of Parent/Guardian:Phone:Date:PLEASE ATTACH PHOTOGRAPH OF STUDENT HERE.LTC APPLICATION 2013