EAGLE SPIRIT HIGH PERFORMANCE CAMP 2017 APPLICATION FORM

INSTRUCTIONSTo complete your submission, you will need to complete and submit:

1. This application form. Please fill it out completely. You may print out the form, fill it in by hand clearly, scan it, and upload it.

2. One reference letter. Referees could be staff at your school, mentors, coaches, community members, or an Elder. You will need to upload a signed pdf document of their letter, which includes their contact information.

3. Camper Questions. Complete the 4 short answer questions in your own words and submit the word/pdf document.

4. Grades. Please upload the most recent copy of your school grades or an interim report.

Please upload all documents (1x complete and signed application form, 1x camper questions document, 1x signed reference letter, 1x grades / recent report card) to the Eagle Spirit Academy Camp Application page. If you have problems completing the process as described above, please do not hesitate to contact us at eaglespiritcamp@gmail.com

If you have no way of submitting the necessary documents online, there is the possibility of using regular mail to post the documents to our office prior to March 15 th, 2017. Note: we will not accept applications received after March 15th, 2017 by mail or online.

CAMPER INFORMATION:First Name: _________________________ Last Name: _____________________________

Telephone: _________________ Age: ___ Birth date (mm/dd/yy)______________________

Camper’s Email Address: _____________________________________________________

Parent /Guardian Name: ______________________________________________________

Parent /Guardian Telephone: _______________ Camper cell phone (optional)____________

Parent /Guardian Email Address:________________________________________________

Current Mailing Address:

__________________________________________________________________________

Nation / Community / Band Name_______________________________________________

Name of School: ____________________________________________________________

Adult T-Shirt Size (S, M, L, XL, 2XL)_____________________________________________

McGill Faculty of Medicine | 3605 Rue de la Montagne, Montreal, Quebec, H3G 2M1 | www.eaglespiritacademy.com

HEALTH / MEDICAL / EMERGENCY INFORMATIONMedical Care Card # _________________________________________________________

Doctor / Physician Name: _____________________________________________________

Emergency Contact Name: ____________________________________________________

Relationship to Camper:_______________________________________________________

Emergency Contact Telephone: ________________________________________________

Please list any current medical Condition(s) / disabilities (if applicable):

__________________________________________________________________________

Please list any previous medical Condition(s) (if applicable):

__________________________________________________________________________

Are you currently taking any medication(s)? If yes, which medications.

__________________________________________________________________________

Please list any allergies / food intolerances or dietary needs:

__________________________________________________________________________

Please list any other information that would be helpful for our team to know for your wellbeing

and safety during the Eagle Spirit Camp:

__________________________________________________________________________

__________________________________________________________________________

EAGLE SPIRIT CAMP SURVEYHave you attended the Eagle Spirit Camp in previous years? If yes, which year?

__________________________________________________________________________

Are you interested in mentorship opportunities following the camp (i.e. during consecutive school year)?

____Yes____No

Where did you hear about the Eagle Spirit Camp? Please check all that apply:

☐ Band/Community Office ☐ School ☐ Family / relative ☐ Word of mouth ☐ Social Media (Facebook, Instagram, YouTube, etc.) ☐ Past Attending Student ☐ Email ☐ Poster or invite☐ Other ____________________________

McGill Faculty of Medicine | 3605 Rue de la Montagne, Montreal, Quebec, H3G 2M1 | www.eaglespiritacademy.com

CAMPER QUESTIONS: Please elaborate & submit approximately 150-250 words for each response in word document or PDF attachment.

1. What does health mean to you?

2. Provide examples of how you have been a health and wellness leader in your

community / school / family.

3. What do you feel are the most important health and wellness issues affecting your

community? How could these health and wellness issues be improved?

4. What are your future goals and dreams you wish to achieve?

REFERENCE LETTER

We request each applicant to submit one letter of support from someone who can attest to the

youth’s character, community involvement, school participation, academic success and/or

interest in health and/or science. The letter of support must be written and signed by a person

unrelated to you with contact information provided). For instance, this individual may be a

teacher, counsellor, principal, coach, cultural leader or Elder.

Name of Referee: ___________________________________________________________

Contact Number / Email: ______________________________________________________

CHECKLIST FOR COMPLETING APPLICATION:___ Completed and signed application form in word document or PDF

___ Completed Camper Questions in word document or PDF

___ One signed letter of support from referee

___ Copy of recent grades from your school

___ Secure round trip travel costs from home community to McGill University.

Please note: All food, accommodations and materials are included for the duration of the camp. You only are responsible for your travel costs to McGill University and any needed spending money.

McGill Faculty of Medicine | 3605 Rue de la Montagne, Montreal, Quebec, H3G 2M1 | www.eaglespiritacademy.com

I certify and agree that the submitted information is true and complete:

__________________________________________________________________________ Name of Applicant Signature Date

__________________________________________________________________________ Parent or Guardian Name Signature Date

CAMP DATES: MAY 18-22nd, 2017

DEADLINE TO APPLY: MARCH 15TH, 2015

Thank you for completing your application and for your interest in the Eagle Spirit High Performance Camp. We look forward to reviewing your application. If your application is complete and you are accepted to attend the camp, you will be contacted in early April 2017.

For more information about the camp, please visit our website: www.eaglespiritacademy.comPlease forward any questions or applications to eaglespiritcamp@gmail.com

McGill Faculty of Medicine | 3605 Rue de la Montagne, Montreal, Quebec, H3G 2M1 | www.eaglespiritacademy.com