Program Registration Package 2008

Please complete the following application. Please note than the following
Your application will not be considered unless fees have been paid in full.

 Program Selection 
 Participant Information 
Name
Date of Birth

Is the participant under 18 at the time of application?
No Yes
(If yes, parent/guardian info must be filled out in the section below)
Gender Male Female
Address
 
City
Prov/State
Postal/Zip Code
Country
Home Phone
Work Phone
Cell Phone
Email
THIS FIELD IS REQUIRED
 Parent / Guardian Information  

(if participant is under 18)

Name
Relationship to Participant
Address
 
City
Prov/State
Postal/Zip Code
Country
Home Phone
Work Phone
Cell Phone
Email

Emergency
Contact

Should the information above be used as the primary contact in case of an emergency?
No Yes
(if yes, skip section 1 below and indicated a secondary contact in section 2)
 EMERGENCY CONTACT INFORMATION 
Name
Relationship
Home Phone
Work Phone
Cell Phone
 SECONDARY EMERGENCY CONTACT 
Name
Relationship
Home Phone
Work Phone
Cell Phone
 HEALTH INSURANCE INFORMATION 
Health Care
Provider
Card or Policy #
 PAYMENT INFORMATION 
I wish to
pay by		 Cheque will be mailed
I will call with a credit card number
Comments
/ Questions
Security Code Code Speaker
 

Privacy Policy

Bytown Brigantine Inc. is a federally registered Charitable Foundation incorporated by letters of patent in the Province of Ontario. Bytown Brigantine Inc. respects your privacy. We collect and use your personal information primarily for the purpose of providing you with the products and services you have requested from us. We protect your personal information and adhere to all legislative requirements with respect to protecting privacy. We do not rent, sell or trade our mailing lists. The information that you provide will be used to allow us to properly conduct our programs, continually improve our programs and service offerings, enable us to more efficiently provide the products and services you have requested from us and allow us to keep you informed and up-to-date on the activities of Bytown Brigantine Inc. A copy of our privacy policy is available at 2700 Queensview Drive, Ottawa, Ontario, K2B 8H6.

This page last updated: Thursday, May 01, 2008 at 09:12

Required Documents

These documents are supplied in Adobe Acrobat form, and must be completed and mailed to BBI in addition to the online application form on this page. The documents must be received by BBI in order to confirm your space on a course:

Health/Medical - Participant Contract

Indemnity Form

Register by Mail

If you wish to register by mail, please download and complete the 13 page application form below:

2008 Registration Form

If you want to participate in our summer youth programs but are worried about money, phone the office at 613-596-6258 and ask about the Thomas G. Fuller Bursary for Youth. It helps pay for some or all of the cost of attending a program based on your family’s situation. Get the details and participate in the experience of a lifetime.

 
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BYTOWN BRIGANTINE INC.
2700 Queensview Drive, Ottawa, ON K2B 8H6 CANADA
phone: (613) 596-6258
contact us by email

Copyright © 2008 Bytown Brigantine Inc. a non-profit charitable foundation (Charitable Registration #118822253 RR0001) dedicated to providing adventure, education, and training in a demanding and rewarding environment.