White City Saskatchewan

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Apply To Camp Molly White City Saskatchewan 2024

Location: White City SK
Camp Date: June 6th - 9th
Registration Opens: Feb 21st
Registration Closes: April 6th

Applicant First Name

Applicant Last Name

Street Address

Town /City

Postal Code

Phone Number

Date of Birth

Ladies T-Shirt Size

Grade of Applicant

School Name

Please provide any medical information that you believe should be known prior to your attendance at this event:

How did you hear about Camp Molly?

If you are under the age of 18, please provide Parent/Guardian details below.

Parent/ Guardian First Name

Parent/ Guardian Last Name

Parent/ Guardian Phone Number

Parent/ Guardian Email

Camp Molly Expression of Interest. Each applicant must also submit a typed essay (no more than 500 words) in the space below. In your response, please describe why you would like to attend the camp this year and outline what qualities you believe someone in the fire service should possess. Please type your response below.

Camp Molly Expression of Interest

Have you participated in Camp Molly in the past?

Are you a member of Girl Guides of Canada or Big Sisters of Canada?

This camp holds dedicated spots for Indigenous campers. Do you identify as Indigenous?

Proof of status to the identified group may be required to participate in those spots reserved for Indigenous campers

Please upload a photo of your status card (if applicable). We accept png, jpg, jpeg, and heic files up to 5Mb

Age at start of Camp?

The following questions will help to ensure that you have a safe physical activity experience. Please answer YES or NO to each question.

Who is completing this section of the application?

I am completing this questionnaire for myself. I am completing this questionnaire for my child/dependent as parent/guardian.

Have you experienced ANY of the following within the past 6 months?

A diagnosis of/treatment for heart disease or stroke, or pain/discomfort/pressure in your chest during activities of daily living or during physical activity? Dizziness or lightheadedness during physical activity? Loss of consciousness/fainting for any reason? A diagnosis of/treatment for high blood pressure (BP), or a resting BP of 160/90 mmHg or higher? Shortness of breath at rest? Concussion? None of the above.

Do you currently have pain or swelling in any part of your body (such as from an injury, acute flare-up of arthritis, or back pain) that affects your ability to be physically active?

Yes No

Has a health care provider told you that you should avoid or modify certain types of physical activity?

Yes No

Do you have any other medical or physical condition (such as diabetes, cancer, osteoporosis, asthma, spinal cord injury) that may affect your ability to be physically active?

Yes No

During a typical week, on how many days do you do moderate- to vigorous-intensity aerobic physical activity (such as brisk walking, cycling or jogging)?

On days that you do at least moderate-intensity aerobic physical activity (e.g., brisk walking), for how many minutes do you do this activity?

To the best of my knowledge, all of the information I have supplied on this questionnaire is correct.

Agree

I hereby certify that the facts set forth in this application are true and complete to the best of my knowledge.

Yes No

Camp Molly offers a unique and rewarding experience, which often captures the attention of media outlets. To ensure that names of students are not published without permission, parents/guardians are asked to sign for consent below. I hereby give permission to have my photo/video and/or my child(ren)’s photo/video taken to be used in any publications, promotional and/or marketing collateral (i.e. brochures, website, advertising, social media, etc.); and local media coverage without compensation. Names will not be published without permission.

Photo and Video Permission

Agree

IF FLAGGED FOR SPAM PLEASE CHANGE YOUR INTERNET CONNECTION OR SUBMIT FROM ANOTHER LOCATION`

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