Call: 780.645.4455


 

 

CL Application Form

Applications for Admission to the Camp Life Program form.

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* Required

Name
First

This is a required question

Middle

This is a required question

Last

This is a required question

Date of Birth

This is a required question

Gender

This is a required question

Address

This is a required question

City/Town/Village

This is a required question

Postal Code

This is a required question

House Location

This is a required question

Alberta Health Care Number (AHC)

This is a required question

Driver’s Licence
*
This is a required question

Learners Permit

*
This is a required question

Email Address

This is a required question

Home Phone

This is a required question

Cell

Message

This is a required question

Marital Status

Maiden Name

Name of Spouse

Spouse Phone Number

Spouse Work Phone Number

This is a required question

Emergency Contact

This is a required question

Emergency Contact Phone Number

This is a required question

Status

Band Name

Treaty Number

This is a required question

Alberta Employment and Immigration Office
Location

First Nations Funder Contact Info/Name/Program:

Metis Settlement Funder Contact Info/Name/Program:

This is a required question

Valid Safety Tickets Info
Check box if they will expire before the BQFNC program end date.
Course

Expires Before Course Ends

Please enter one response per row

Accepted
FOR OFFICE USE ONLY
This is a required question

If not Accepted what is the explanation
OFFICE USE ONLY

This is a required question

Training Date Start

This is a required question

Training Date End

This is a required question

Signature:
NOTE: Online applicants will be required to sign a form at the time of registration.
I authorize an investigation of all statements contained herein. I understand that misrepresentation or omission is cause for refusal of admission or dismissal. NOTE: Applications cannot be processed until all official transcripts, certificates, and application fees are received. Did you answer all the questions to the best of your knowledge before signing the application form?

This is a required question

Date Signed

This is a required question


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