ROBSI Registration Form 2024

ROBSI 2024 Registration Form

IMPORTANT NOTE, Please read before you complete this form:

Please review this Registration Form prior to filling it out. Make sure you have all the required information at hand before starting. You will need to provide a current photograph of the participant as well as a photo of their Health Card. Most fields are "required", you will not be able to complete this form unless you provide all the information asked for.

* Indicates a required field.

Thank you!

If you need help with this form, please contact us Here.

Program Choice:

Junior/Senior Program

CIT Program

Murphy's Point Program

Canoe Out Trip

Participant's Information:

Participant's First Name:

Participant's Last Name:

Participant's Email:

Address

Date of Birth

NOTE: Select year of birth first

Participant's Gender:

Note: This information helps us to assign dorm placement.

Male

Female

Other

If "Other", please give details:

Height:

Weight:

Eye Colour:

Hair Colour:

Eye Wear:

Does the applicant wear any of the following?

Glasses

Contacts

Both

Neither

Orthodontic Appliance:

Does the applicant have an orthodontic appliance?

Yes

No

T Shirt Size:

Youth Large

Adult Small

Adult Medium

Adult Large

Adult XL

Adult XXL

Photo:

Please attach a current "Head Shot" profile photo. Note: Please keep file sizes small (4"X6") is perfect!

Parent or Guardian Information:

Parent or Guardian First Name:

Parent or Guardian Last Name:

Phone:

Parent or Guardian Email:

Waiver and Medical Information:

Health Coverage:

Does the participant have a Provincial Health Card? Note: Participant must have health insurance. If they do not have a Provincial Health Card and/or are from outside Canada, please complete the alternate Health Coverage section.

YES

NO

Health Card Photo:

Please supply a photo of the participant's OHIP Card, Health or Travel Insurance Card. Note: Please keep file sizes small (4"X6") is perfect!

Health Card No.

Health Card Province:

Health Card Expiry Date:

Alternate Health Coverage:

Serious Allergies?

Does the participant have any life-threatening allergies?

YES

NO

NOTE: If YES, a Medical Waiver Form must be submitted prior to the participant attending ROBSI. A link to download the Medical Waiver Form will be available at the completion of the registration process.

If "YES", please give details:

Non-serious Allergies:

Does the participant have any non-life-threatening allergies?

YES

NO

If "YES", please give details:

Health Status:

Does the participant have any physical or emotional limitations?

YES

NO

NOTE: This exciting program includes swimming, canoeing and other physical activities: Is there any reason (physical or emotional) that would make participating in these activities difficult?

If "YES", please give details:

Dietary restrictions:

Does the participant have any dietary restrictions?

YES

NO

If "YES", please give details:

Acetaminophen:

Permission to Administer Acetaminophen: Note: We use a generic Tylenol Acetaminophen.

YES

NO

If "NO", permission to give alternative:

Specify an alternative.

Parent or Guardian Consent:

I consent and/or agree to the conditions outlined below:

YES

NO

Parent or Guardian's Consent: By choosing "YES" it is understood that you hereby give permission for your child and/or ward to attend the above noted program and to participate in all supervised activities and authorize those in charge of the program to secure such medical advice and services for the above named as may be deemed by them as necessary, and agree to accept financial responsibility for any charges incurred (Example: Those not paid by provincial medical insurance.)

Permissions:

I grant permission to video record and/or use photo:

YES

NO

Note: A group photo is normally taken at ROBSI. Also, candid photos are sometimes used for advertising purposes on our website, in emails and printed brochures.

Alternate Contact

Alternate Contact:

Alternate contact if the parent or guardian is not available in an emergency.

Phone:

Additional Comments:

Program Fee Payment:

NOTE: Shortly after submission of your form, you will receive an invoice for payment of program fees. Thank you!

Program Fee Amount:

The program fees are: Junior/Senior Program $340.00. CIT Program $340.00. Murphy's Point Program $360.00. Canoe Out Trip Program $360.00.

Junior/Senior Program $340.00

CIT Program $340.00

Murphy's Point Program $360.00

Canoe Out Trip Program $360.00

Select the correct program fee for this registration

Your registration form has been sent. You will receive an email invoice shortly. Thank You!