Registration Information Form – March Break Bash

March Break Bash

In order to finalize your registration you will need to complete the form below. A link to the form has also been included in your confirmation email, should you wish to complete the form at a later date.

NOTE: This form must be completed in full detail before participating in the March Break Bash.

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Name
Please select the size of t-shirt you would like to receive.
Name
Does the youth require medication to be given during their time at camp? (If yes, please note there is additional paperwork to be completed with an Empower Simcoe employee)
We request that all medication be blister packaged.
Does your youth carry an Epi-pen for any allergies?
*Please note we do not guarantee an allergen-free environment
Will your youth be attending the March Break Bash with a 1:1 Support Worker?
Please include as much detail as possible.
Activities of daily living: using the toilet, eating, etc.
Does the youth have any hearing issues?
Does the youth have any vision issues?
Does the youth have any of the following health conditions?
How does the youth communicate with others?
Does your youth require or use a wheelchair or other mobility aid?
Please check the corresponding level of support most often required by your youth
This does NOT indicate the level of support they will be receiving at the March Break Bash.
What level of support does your youth require at meal time?
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