A partnership between Patient & Community Partnership for Education in the Office of UBC Health and the community.
An e-mail will be sent to confirm your registration
*Required Inputs
First Name: *
Last Name: *
House Address: *
City: *
Province: * —Please choose an option—British ColumbiaAlbertaManitobaSaskatchewanOntarioQuebecNova ScotiaNew BrunswickNewfoundland and LabradorPrince Edward IslandNorthwest TerritoriesNunavutYukon
Postal Code: *
Phone #:
E-mail: *
Program of Study: *
Year: * —Please choose an option—1st Year2nd Year3rd Year4th YearOther
Emergency Contact:
Relationship to you:
Emergency contact phone #:
Have you had a criminal record check completed in the past 5 years?: YesNoUnsure
* You must complete a free online criminal record check in order to participate in this program. Instructions will be provided following receipt of your application.
We may contact each applicant's academic department to confirm enrolment and good standing. Do you consent to PCPE contacting your department for this purpose? YesNo
Do you hold a valid driver's License? YesNo
Do you have any dietary restrictions? If so, please specify:
Do you have access to a vehicle to assist with carpooling fellow students to/from the camps? YesNo
In which Camps are you interested? Please list the camps in order of preference 1. Caregiver Camp (foster families)Natural Changes Camp (women and girls only)Warrior Camp (men and boys only)Family CampYouth Day Camps 2. Caregiver Camp (foster families)Natural Changes Camp (women and girls only)Warrior Camp (men and boys only)Family CampYouth Day Camps 3. Caregiver Camp (foster families)Natural Changes Camp (women and girls only)Warrior Camp (men and boys only)Family CampYouth Day Camps
Please provide one or two brief paragraphs describing yourself, your area of study, and your interest in joining the Community as Teacher camps:
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