Register for She Can! March Break Camp

Camp Information

Camp Name

For Girls in Grades

Cost

CAD

Session Start Date

mm/dd/yyyy

Time

Duration

Location

Session ID

Child Information

Child's First Name

Child's Last Name

School Child Currently Attends

Grade

Birthdate (mm/dd/yy)

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Phone Number

Email Address

Street Address

Town/City

Postal Code

Participant Medical Information

Does your participant have any medical conditions, allergies or medications we should know about?

YesNo

Please provide additional medical information (including if your child has a puffer or epi-pen)

Do you give permission for She Can! to take your participant, by walking, to Bronte Meadows Park?

YesNo

Emergency Contact First Name:

Who should we call if we can't reach you?

Emergency Contact Last Name:

Emergency Contact Phone Number:

Must be different from parent phone number listed above.

Relationship to child

I understand that the She Can! Girls Empowerment Programs are for girls (inclusive of cisgender and transgender girls and nonbinary youth).

I grant MCRC permission to use photos of my participant on their social media accounts, website, and on promotional materials. (Optional)

I would like to be added to the She Can! Email Mailing list. (Optional)

Payment Information

Total Amount Due (CAD):

Your credit card will be charged this amount when this form is submitted.

Name on Card

Card Number

Code

Billing Email

Demographic Information

She Can! is asking parents/guardians to provide the following demographic information on behalf of their participant and family. We are collecting this information in order to identify and remove barriers to entry for our program, ensure equitable service delivery and programs, and be proactive in meeting the needs of our community.

Every question is optional, and you can choose to leave the question blank or select ‘choose not to answer’.

Your answers will be anonymous and this information will be kept confidential.

Please contact the She Can! supervisor at jessica.lowe@mcrc.on.ca with any questions or concerns

What racial group best describes your participant?

A racial group not listed above

What is your participant's current citizenship status?

What is your participant's gender?

A gender identity not listed above

Do you consider your participant to be a person with a disability?

What is your family's household income?

Contact Information