Parent/Guardian Information

Prairie English Camp

Box 67, Grenfell, Saskatchewan Canada

Phone: 306-361-3432   piotld@sasktel.net

Summer Camp

July 21 – August 17, 2013

Page 1 of 6 – Family – Student information

Family/Guardian Information
Father: Name ___________________________Home address ____________________________________________________________________Phone (home) ______________________           (work) ______________________            (cell) _______________________

Email _____________________________

Mother:Name ___________________________Home address ____________________________________________________________________Phone (home) ______________________           (work) ______________________            (cell) _______________________

Email _____________________________

Student #1Name: _______________________________________________________________________                        (First)                           (Middle)                                   (Last)Male _____________             Female _____________Home address:  ________________________________________________________________Home phone number: ___________________________________________________________Birth Date: __________________________________________   Age:  ___________________

Passport: ____________________________________________

(country)                      (number)

Grade level in 2012-2013: ________________________________

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