1-50

20

19

LAKEFIELD CAMP INTERNATIONAL

A CANADIAN CAMP EXPERIENCE YOU CAN CALL YOUR OWNLakefield Camp International welcomes campers for an unfortgettable summer of learning, recreation, and friendship in the beautiful

Kawartha Lakes region of Ontario. Operating on the stunning grounds of Lakefield College School, our camp offers students a variety

of course options. Campers take advantage of modern classrooms, well-equipped athletic facilities, expansive playing fileds, and direct

waterfront access. Sports and arts programming may be combined with traditional ESL instruction or one of our innovative specialty

programmes.

Dates 7 weeks: June 30 - August 17

LocationLakefield, Ontario (near Peterborough)

Campus Private High School Campus

Gateway Toronto, Ontario (YYZ)

Ages - Camp 9-16 • Boys & Girls

Ages - Leader in Training 17 • Boys & Girls

Capacity 175

AccommodationSchool Residence Double or Triple room

Meals 3 meals daily + evening snack

Programme Options

General English 10hrs/wkGeneral English 15 hrs/wkWilderness Education 10hrs/wkEnglish through Drama 10hrs/wkActivity Camp Leader in Training (LIT)

Activities Daily - various

Included Excursions1 Full Day Toronto excursion every 3 weeks

Optional Excursions Available weekly

Study Permit Not required

Individuals Accepted

Groups Accepted

Group LeadersAcceptedAccommodated on campus

REGISTRATION FOR ENGLISH, WEP, DRAMA OR ACTIVITY CAMP REQUIRED AT TIME OF BOOKING

OVERVIEW

MAIN FEATURES • Traditional summer camp with benefit of residential accommodation and modern facilities• Specialty programming: General English, English through Drama and Wilderness Education Programme • Leadership Training programme for 17 year olds

• Group bookings available

AGES 9-16 LIT-17

ONTARIO

Lakefield

Toronto

DATES 2019 7 weeks DEPARTURE DATE (by session length)

SATURDAYS

ARRIVAL DATE

SUNDAYS 4 weeks 3 weeks 2 weeks

June 30 July 27 July 20 July 13

July 07 August 03 July 27* July 20

July 14 August 10 August 03 July 27

July 21 August 17 August 10 August 03

July 28 xx August 17 August 10

August 04 xx xx August 17

* Leader in Training session

1-51

20

19

LOCATIONThe village of Lakefield is located close to the city of Peterborough, approximately 150km northeast of Toronto. Lakefield sits on the southeast shore of Lake Katchewanooka, and is part of the Kawartha district of Ontario, a region rich in natural beauty and home to many private cottages and resorts. The camp operates on the grounds of Lakefield College School, a prestigious Canadian private boarding school.

Distances from campus:• Pearson International Airport (YYZ) = 150 km• Niagara Falls = 280 km

NEARBY AMENITIES• Village of Lakefield is within walking distance of camp• Walk-in Clinic - 2.5 km from campus in Village of Lakefield • Hospital - 18 km from campus in Peterborough

ACCOMMODATION: RESIDENCE HOUSESResidence houses each vary in terms of size. Rooms have 2-3 beds, Common bathrooms with multiple toilets and showers are on each floor. Girls and boys are in different houses, with staff living on each floor.

Residence Room includes: 2-3 individual beds, desk, chair, dresser and/or wardrobe

Room Style Double or Triple Rooms

Boys & GirlsAccommodated in separate residence houses and placed according to age

Supervision Counsellors live in residence houses with campers

Bed Linens Included & changed weekly

Pillows & Blankets Included

Towels Not provided

Laundry Service once weekly - included

Telephone All calls must be made using Skype® or personal phones

Internet / WiFi WiFi available - but use is limited (see policy below)

Toilets Shared common on residence floor (1:5 ratio)*

Showers Shared common on residence floor (1:5 ratio)*

MEALS3 meals daily + Snack Breakfast, Lunch, Dinner

• Evening snack included nightly• Nutritious and well-balanced meals served buffet-style in school dining hall

FACILITIES: • Classrooms - large, well equipped & air-conditioned• Dining Hall• Common rooms - air conditioned• Playing fields• Tennis courts• Basketball courts• Outdoor Running track• Waterfront area• Boathouse

LAKEFIELD CAMP INTERNATIONAL

• Gymnasium (indoor-only sport shoes required in gym)

• High and Low Ropes Course with Climbing Wall• Student recreation centre• Dance studio• Computer lab with internet• Infirmary with health care provider

1-52

20

19 LAKEFIELD CAMP INTERNATIONAL

DAILY PROGRAMMING

MONDAY TO SATURDAY (excluding excursion days)

Morning 07:3008:00 - 08:4008:40 - 09:1009:15 - 10:1510:25 - 11:2511:35 - 12:35

Wake upBreakfastHouse clean-upPeriod 1 Period 2 Period 3

Afternoon 12:45 - 13:4513:45 - 14:4514:50 - 15:5016:00 - 17:0017:00 - 17:40

LunchRest PeriodPeriod 4Period 5REC Period

Evening 18:00 - 19:0019:00 - 20:3021:0021:30 - 22:00

22:00 - 23:00

DinnerEvening ProgrammeSnackAll students in rooms (by age)

Lights out (by age)

SUNDAYS Leisure Time & Theme day activities

Schedule may change on excursion days

PROGRAMME OPTIONS

Campers select their programme choice

at time of booking

ENGLISH PROFICIENCY recommended

CLASS

PERIODS per day

ACTIVITY

PERIODS per day

BEG PINT ADV out of 5 daily periods:

GENERAL ENGLISH

10 hours/week 2 3

15 hours/week 3 2

SPECIALTY

PROGRAMMES

English through Drama10 hours/week

2 3

Wilderness Education10 hours/week

2 3

ACTIVITY CAMP

Activities Only 5

LITLeader In Training(age 17 only)3 week programme

Customized Programme

(see details)

NOTES:

1. Students attending for 2 and 3 week sessions: only one programme choice possible

2. Students attending for 4 or 5 week sessions: more than one programme choice possible (minimum 2 weeks of each)

3. Programme switches are strongly discouraged as they are disruptive to the class dynamics. If a students wishes to change their programme

option while at camp, CISS requires written authorization from the student's natural parent(s) or guardian.

4. Programme changes, once approved, will only be made at the start of the week.

OR

OR

STRUCTURE: • All students taking English are tested on their first

Monday at the programme, and placed in a level-appropriate class

• Students are given a full orientation on their first day and all the rules about safety are carefully explained

• 5 x 1-hour periods + REC take place 5 days per week

• At the beginning of each week, students select their activities from a wide variety of water and land sports

• Students attend their chosen activities for one-week blocks, ensuring that they develop solid skills in those particular areas

• General English (10 or 15 hours), English through Drama or Wilderness Education comprise 2 or 3 periods daily

• On Sundays and on days when optional excursions are offered, the daily programme is modified to allow for group activities rather than the typical daily choices.

OR

OR

IMPORTANT!

1-53

20

19

LAKEFIELD CAMP INTERNATIONAL

ESL- ENGLISH AS A SECOND LANGUAGE PROGRAMMEOur language classes follow a curriculum designed to aid foreign language learners to further their fluency and accuracy in English. With a focus on communication, lessons are designed for group oral activities as well as individual tasks in grammar, writing and reading.

10 HOURS PER WEEK 15 HOURS PER WEEK

• 2 periods daily • 10 hours of instruction per week• 1 hour = 60 minutes• 3 levels of ESL available (Beg/Int/Adv)• Small classes - max. 15 students, average 13 students

• 3 periods daily • 15 hours of total instruction per week• 1 hour = 60 minutes• 3 levels of ESL available (Beg/Int/Adv)• Small classes - max. 15 students, average 13 students

LANGUAGE INSTRUCTORS:• All ESL instructors have TESL certification or a teaching degree (B.Ed)• ESL instructors use modern communicative and task-oriented methodologies including group activities and role-

playing for effective language development

ENGLISH THROUGH DRAMA Drama is an excellent educational alternative to the ESL programme and is available for students of all English levels. Drama has been shown to increase confidence and enhance public speaking and pronunciation skills. The use and mastery of language through short rehearsed performances offers students new opportunities to improve fluency in a supportive and structured environment.

DRAMA INSTRUCTION

• 2 periods daily• 10 hours per week (2 week minimum participation)• 1 hour = 60 minutes• Experienced drama instructors• Small groups• Campers of ALL language proficiency levels accepted• Weekly modules with short performances at the end of each week

OR

1-54

20

19

LAKEFIELD CAMP INTERNATIONAL

WILDERNESS EDUCATION PROGRAMME (WEP) The Wilderness Education programme is an excellent educational alternative to the ESL programme for students with an intermediate or high English proficiency. Lessons focus on sustainable environmental practices, native culture, wilderness exploration and discoveries unique to the local Canadian landscape. Lakefield has special access to a beautiful, typical Canadian landscape, which is the perfect setting for this increasingly popular and important study topic.

WEP INSTRUCTION COMPONENTS OF WEP

• 2 periods daily• 10 hours per week (2 week minimum participation)• 1 hour = 60 minutes• Experienced outdoor education instructors• Small groups• Weekly themed components• Daily journal recordings and Resource Book provided• Campers must have an intermediate or high

functioning English proficiency

1. Survival Skills: Shelter building, wilderness survival, campfire cooking, weather prediction

2. Camping Experience: Trip planning, mapping routes, dehydrating food, overnight camping

3. Native Canadian Studies: Learning about Native Canadians, their history, crafts, traditions and diet

4. Outdoor Skill Building: Canoeing, low and high ropes challenges, Compass and Map reading

5. Environmental Issues: Sustainable living, watershed management, study of local flora, fauna, and wildlife

ACTIVITY CAMP Students may choose Activity Camp, which means that they do not take any other programme options such as General English, English through Drama, or Wilderness Education. Activity Camp gives students an opportunity to use all five daily periods devoted to the activities of their choice.

ACTIVITY CAMP

• 5 periods daily• 25 hours per week• 1 hour = 60 minutes• Qualified and experienced instructors• All levels of English proficiency

1-55

20

19

INSTRUCTED ACTIVITIES

DAILY INSTRUCTED ACTIVITIESALL CAMPERS have the opportunity to select and participate in general interest activities as follows:

Activity Camp: 5 instructed activity periods daily + REC period10 hours ESL, WEP or DRAMA: 3 instructed activity periods daily + REC period15 hours ESL: 2 instructed activity periods daily + REC period

Campers select their weekly activity choices from the list below. All activities are supervised and instructed in English. Each activity period lasts for 1 hour (60 minutes) daily.

ACTIVITY INSTRUCTORS• Activity instructors have proven competency skills in each of their activities• Lifeguards and activity instructors have certification in accordance with OCA (Ontario Camps Association) regulations

WATER ACTIVITIES SPORTS & ADVENTURE

• Canoeing • Sailing • Kayaking • SUP (Stand Up Paddleboard) • Swim Lessons • Windsurfing

• Archery • Mountain Biking• Basketball • Soccer• Beach Volleyball • Tennis• Canadian Sports

ARTS & MOVEMENT REC PERIOD ("REC")

• Arts & Crafts • Guitar (beginner)

• Dance • Theatre On regular camp days, 1 hour is allocated as a REC Period (REC). During REC, a variety of water and land sports & activities are offered, with the addition of the following specialized activities:

• Ropes & Climbing Wall

Campers have the opportunity to participate in different REC activities on a daily basis. All activities are supervised but not instructed.

HIGH ROPES / LOW ROPES / CLIMBING WALL

Professional instructors supervise and instruct campers in proper technique and safety. All students wear appropriate helmets and safety harnesses at all times.

LAKEFIELD CAMP INTERNATIONAL

1-56

20

19

LAKEFIELD CAMP INTERNATIONAL

LEADER IN TRAINING (LIT) The Leader in Training (LIT) programme is focused on leadership development for youth aged 17 years old who hope to become future leaders either in a camp or similar educational setting. Participants acquire valuable leadership skills during specialized morning classes, designed to prepare them for their practical sessions. Afternoons offer hand-on experience, as they shadow experienced Lakefield staff during activity periods. LITs are mentored throughout the programme by senior staff.

LIT PROGRAMME STRUCTURE IN-CLASS LESSON COMPONENTS

The Leader in Training programme puts the concept of "leadership" into motion by providing participants with a combination of theoretical knowledge and practical hands-on experience in a camp environment. Morning lessons focus on examining theories, models, and types of leadership. LITs learn various techniques used by educators to lead and support younger children, including strategies for different scenarios that apply to a camp setting. Afternoons provide LITs with an opportunity to apply their new knowledge, as they assist camp staff in leading various camp activities and organizing different programmes. Participants are sure to leave the programme with new skills and experience that will serve them for a lifetime.

• 10 hours of specialized training classes per week• 1 hour = 60 minutes• 3 periods daily of supervised practical training while

learning to lead and teach activities• LITs work closely with an LIT Coordinator who supervises,

guides, and mentors the participants• First Aid Training included for all participants• Acceptance is pending full completion of a special

application, designed to assess English proficiency and relevant experience

• LITs must have a high functioning English proficiency as ESL is NOT a component of the programme

Morning lesson topics may include:• Camper safety and well-being• Crisis management• Time management skills• Organizing and planning activities• Working with children of different age groups• Conflict resolution• Creating positive team dynamics• Understanding different leadership styles• Effective communication within a team environment

PRACTICAL SKILL ACQUISITION

Afternoon practical programme components:• Assisting with activity instruction• Coaching children• Planning evening programmes• Self-reflection (Journal writing)

PROGRAMME OUTCOMES

Upon successful completion of the programme, participants can expect to receive:• First Aid Training• Leader in Training Completion Certificate• Performance Evaluation from LIT Coordinator

LIT PRACTICUM [NEW]

LITs who successfully complete their 3 week programme may extend their stay at Lakefield as part of the the LIT Practium. LITs have a chance to put their newly acquired skills to the test by assisting staff in a broader capacity. Participants may stay from 1-3 weeks.

NOTE: 1. LITs are expected to participate fully in the general Lakefield Camp programme when not involved in components of their LIT training. Attendance is mandatory at ALL functions and camp-wide activities.

DATES FOR SUMMER 2019

3 weeks: July 07 - July 27

NOTE: LIT candidate must enrol for entire session!

AGE 17

1-57

20

19 LAKEFIELD CAMP INTERNATIONAL

EVENING PROGRAMMEThe evening programme is an opportunity for students and staff to do activities together. The programme is mandatory and is a combination of house-based activities and leisure options. Students from each residence house may team up to face each other in competition. Students may also enjoy camp-wide activities including the following:

• Banquets• Campfires • Camp Games• Cardboard boat races• Dances

• Overnight camping• Special interest groups• Sports Games• Talent Shows

Note: Some scheduled or optional full day excursions may run into the evening.

SCHEDULED EXCURSIONSFull Day: 1 every three weeks

• Toronto tour + shopping

Excursion is not guaranteed to participants enrolled for less than 3 weeks

OPTIONAL EXCURSIONS (not included)

Select optional excursions are offered to all campers at an extra fee. Excursions offered are dependent upon session dates and duration. All excursions are fully supervised by camp staff and include transportation, admission costs and meals as required.

Optional excursions may be paid for at camp or pre-paid to the representative prior to arrival at camp. Clients wishing to pre-pay for optional excursions must indicate this at time of booking. Otherwise, campers can choose to attend an optional excursion after they have arrived at the programme and money is automatically deducted from their student bank account accordingly.

Full Day OPTIONAL Cost:

• Canada’s Wonderland (Amusement Park) $80 CAD

• Disco Boat Cruise on Lake Ontario $65 CAD

• Niagara Falls (includes Hornblower boat tour) $120 CAD

• CN Tower (add-on to Toronto tour) $45 CAD

Note: Students who attend an optional excursion do not have activities or language instruction on that day. Leaders in Training have the option to

pay and participate in the optional excursions as "campers" or they can choose to attend free of charge, but will have supervised responsibilities as

part of their LIT course.

1-58

20

19

LAKEFIELD CAMP INTERNATIONAL

QUALITY STAFFCISS is proud to have earned a reputation for recruiting motivated, caring and qualified personnel. Our commitment to providing an organized workplace and strong leadership has allowed us to attract seasonal employees that return year after year. Our hiring standards follow strict guidelines and adhere to the policies set forth by regulatory bodies such as the Ontario Camps Association. Our staff are trained in safety procedures, First Aid and childcare prior to the programme season and are prepared to manage all situations without compromise to the care and programming for other students.

SUPERVISION• CISS takes safety and supervision at our waterfront programme sites very seriously. Therefore, we provide an overall

staff to student ratio of approximately 1:5 at Lakefield Camp, providing excellent care and supervision of children• CISS staffing ratios ensure that staff are available to handle emergency situations (ie. take a student to see a doctor)

without compromising the supervision or instruction of other campers• Staff to camper ratios for all waterfront activities comply with standards set by the Ontario Camps Association,

providing a high level of water safety• CISS staff are available 24 hours, and live with students on the same residence floors, ensuring that an adult is always

available

• Staff conduct routine evening and night patrol

PARENT COMMUNICATION Unless it is an emergency, we ask that parents refrain from calling the camp directly. Campers are encouraged to call home upon arrival, and then once weekly. Below is a detailed description of the different ways in which campers may communicate with their parents.

CELL PHONE AND ELECTRONIC DEVICES: Campers who choose to bring a mobile device do so at their own risk, but will be limited to when they can use it (see below). Campers are not permitted to bring or use any devices during classes, meals or any activities. Devices are kept in the camp office or in another secure location and can only be signed out on designated days. CISS/Lakefield Camp is not responsible for lost, stolen, or damaged devices.

E-MAIL: There is WiFi on campus. Campers who need to communicate with their parents using an internet connection may do so ONLY on days when they are permitted to use their mobile or electronic device.

SKYPE®: Students who do not have a mobile device may call home using a pay phone or by using SKYPE through one of the computers on campus. Campers who do not already have a Skype® account may use the camp account, and are charged according to their usage time.

CISS CELL PHONE AND ELECTRONIC DEVICE POLICY:

The cell phone and electronic device policy at Lakefield Camp for 2019 will be as follows, without exception:

All camper devices are collected by programme staff upon arrival, during the check-in process. Devices are labeled and kept in a secured location. Campers are allowed to retrieve their devices twice per week. Once, on the evening prior to the scheduled Optional or Included Full-Day Excursion and again on the night before departures. Campers have use of their devices for a 24-hour period after which they must then return their devices to the programme staff, where they are stored again until the following week or until the camper departs.

During the time that campers have access to their devices, they must adhere to the following rules:

• Cell phone or electronic devices may be used during excursions, but within certain parameters• While on-campus, devices may only be used during specified time periods - campers may not talk on their cell

phone late at night or during group-based activities, where use of the device may be disruptive to others• All devices must be turned off at night so not to awaken other campers• CISS/Lakefield Camp is not responsible for devices that are lost, stolen or damaged

1-59

20

19

LAKEFIELD CAMP INTERNATIONAL

PROGRAMME INCLUSIONS

Accommodation Double or triple rooms

Meals 3 daily, plus evening snack

Supervision

Study Materials

Sheets & Pillows

Blankets

Towels Must bring own

Laundry Once weekly service

Linen change Once weekly

English Hours(optional)

10 or 15 hrs per week

Wilderness Education(optional)

10 hrs per week

English through Drama(optional)

10 hrs per week

Full Day Excursion* 1 per 4-week session

Daily Activities Student-selected

Evening Programme Nightly

Sports Facilities

Airport Transfers Arrival & Departure

Medical Insurance $100,000 CAD

Emergency Dental Included in above

Healthcare Provider On campus

CISS T-Shirt Upon Arrival

Programme Certificate Upon Completion

* Shopping Excursion not guaranteed to participants enrolled for less than 3 weeks.

Students have time for shopping while on the optional excursion.

EXTRA EXPENSES

Optional Activities Admission + transportation costs

Extra Day stay* $200 CAD per night

Extra transfer fee $150 CAD If arriving/departing on non-scheduled day

Personal Spending $ -- at discretion for personal shopping

Early Morning Departure Fee

$150 CAD If flight is scheduled to depart before 08:00

Notarized Custodianship Fee

$100 CAD (if required)

CISS Unaccompanied Minor fee**

$100 CAD (if required)

* Students arriving early or departing late from the programme

will be charged extra day fees. Charges for extra days include

accommodation, meals, supervision, medical insurance and

programming as per the schedule.

** Students arriving and/or departing as Unaccompanied Minors must

register with their airline in advance and pay associated fees to the

airline directly. For all students registered as UM, CISS will charge an

additional fee.

1-60

20

19

LAKEFIELD CAMP INTERNATIONAL

4 week SAMPLE calendar

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

Morning

Arrivals

Orientation, ESL

Testing

Activity Periods I-III

Activity Periods I-III Activity Periods I-IIICustomized Activity

Periods

OPTIONAL

EXCURSION:

Canada’s Wonderland

Activity Periods I-III Activity Periods I-III

AfternoonActivity Periods IV-V Activity Periods IV-V Activity Periods IV-V Activity Periods IV-V Activity Periods IV-V

REC Period REC Period REC Period REC Period REC Period

Evening House activityCamp Game

“Capture the Flag”

Camp Game

“Counsellor Auction"Campfire

Cardboard Boat

Races

Morning Arrivals / At leisure Activity Periods I-III Activity Periods I-III Activity Periods I-III

Customized Activity

Periods

OPTIONAL

EXCURSION:

Niagara Falls

Activity Periods I-III Activity Periods I-III

Afternoon Theme Day and

House Activities

Activity Periods IV-V Activity Periods IV-V Activity Periods IV-V Activity Periods IV-V Activity Periods IV-V

REC Period REC Period REC Period REC Period REC Period

Evening Sports House ActivityCamp Game

“Stones”Talent Show Dance Sports Games

Morning Arrivals / At leisure Activity Periods I-III Activity Periods I-III

FULL DAY

EXCURSION:

Toronto Tour +

Shopping

OPTIONAL:

CN Tower and/or

Disco Boat Cruise

Activity Periods I-III Activity Periods I-III Activity Periods I-III

AfternoonTheme Day and

House Activities

Activity Periods IV-V Activity Periods IV-V Activity Periods IV-V Activity Periods IV-V Activity Periods IV-V

REC Period REC Period REC Period REC Period REC Period

EveningCamp Game

“Phobias”House Activity

Camp Game

“Survival"

Cardboard Boat

RacesBanquet Theme Dance

Morning Arrivals / At leisure Activity Periods I-III Activity Periods I-III Activity Periods I-IIICustomized Activity

Periods

OPTIONAL

EXCURSION:

Niagara Falls or

Canada's Wonderland

Activity Periods I-III

AfternoonTheme Day and

House Activities

Activity Periods IV-V Activity Periods IV-V Activity Periods IV-V Activity Periods IV-VDepartures

REC Period REC Period REC Period REC Period

EveningCamp Game

“Stones”House Activity Hobby Night Talent Show Campfire

This schedule is a sample only. Finalized programme calendar to be published on the CISS website/Agent Zone

Notes:

1. Optional activities are listed in italics (extra fees apply).

2. Group requests may include Optional Activities at point of quotation.

SUMMER 2019 APPLICATION

1 of 3

PROGRAMME CHOICE 4 week sessions: 3 week sessions: 2 week sessions:

CITY

RES

IDEN

TIA

L

CISS Vancouver (YVR Gateway)

Arrivals: MondayDepartures: Monday

Global English (22hrs) July 01 - July 29July 08 - Aug 05July 15 - Aug 12

July 01 - July 22July 08 - July 29July 15 - Aug 05July 22 - Aug 12

July 01 - July 15July 08 - July 22July 15 - July 29July 22 - Aug 05July 29 - Aug 12

CISS at Trinity (YYZ Gateway)

Arrivals: SundayDepartures: Saturday

General English (20 + 5 Practical Hrs)

Academic & Career Prep (25hrs)*June 30 - July 20 or July 21 - Aug 10

June 30 - July 27July 07 - Aug 03July 14 - Aug 10July 21 - Aug 17

June 30 - July 20*July 07 - July 27July 14 - Aug 03July 21 - Aug 10*July 28 - Aug 17

June 30 - July 13July 07 - July 20July 14 - July 27July 21 - Aug 03July 28 - Aug 10Aug 04 - Aug 17CISS St. Michael’s

(YYZ Gateway)

Arrivals: SundayDepartures: Saturday

General English (20 Hrs)

Global Leadership (20 Hrs)*June 30 - July 20 or July 21 - Aug 10

SUM

MER

CA

MPS

Lakefield Camp (YYZ Gateway)

Arrivals: SundayDepartures: Saturday

Optional Activities & LIT Practicum

10 Hrs General English 15 Hrs General English Activity Camp English through DramaWilderness Education Programme (WEP)Leader in Training (LIT)*July 07-27

June 30 - July 27 July 07 - Aug 03 July 14 - Aug 10 July 21 - Aug 17

June 30 - July 20July 07 - July 27*July 14 - Aug 03July 21 - Aug 10July 28 - Aug 17

June 30 - July 13July 07 - July 20July 14 - July 27July 21 - Aug 03July 28 - Aug 10Aug 04 - Aug 17

Niagara Falls (July 11 & 25, Aug 01 & 15)

Disco Boat Cruise (July 17)

Canada’s Wonderland (July 04 & 25, Aug 01)

CN Tower (July 17 & Aug 08)

LIT Practicum: 1 week (July 28 - Aug 03)2 weeks (July 28 - Aug 10)3 weeks (July 28 - Aug 17)

Swallowdale Camp (YYZ Gateway)

Arrivals: SundayDepartures: Saturday

Optional Activities & LIT Practicum

10 Hrs General English Activity Camp Leader in Training (LIT) *July 07-27

June 30 - July 27 July 07 - Aug 03

July 14 - Aug 10

June 30 - July 20 July 07 - July 27* July 14 - Aug 03 July 21 - Aug 10

June 30 - July 13 July 07 - July 20 July 14 - July 27 July 21 - Aug 03 July 28 - Aug 10

Niagara Falls (July 03, 17, 31)

Canada’s Wonderland (July 10 & 24, Aug 07)

LIT Practicum: 1 week (July 28 - Aug 03) 2 weeks (July 28 - Aug 10)

NO

TES • LIT (Leader in Training), Global Leadership or Academic & Career Prep programme require a separate application form that must be

completed to assess English and aptitude levels for the programme. • Optional activities and LIT Practicum add-on weeks are an additional cost. Please refer to the CISS MLI Price List for further information or

contact your agent or CISS MLI representative.

Application Date:

2019 PROGRAMME SELECTION

First Name:

Last Name:

Address:

City: Province / State:

Country: Postal Code:

Home Tel: Student Mobile:

Birth Date (MM/DD/YY): Age at camp:

Male Female Nationality:

Agency (if applicable):

Passport #: Expiry Date:

STUDENT/CAMPER INFORMATION

Parent #1 - Name: Last Name:

Mobile Tel: Email:

Parent #2 - Name: Last Name:

Mobile Tel: Email:

Parents are: Married Divorced Common-Law Widowed

Student Lives with: Parent #1 Parent #2 Other:

If divorced, who has legal custody? Parent #1 Parent #2 Other

Does non-custodial parent have visiting rights? Yes No

Emergency Contact - Name: Last Name:

Mobile Tel: Relation to child:

PARENT/GUARDIAN INFORMATION

STUDENT: DATE:

2 of 3

ALLERGIES: Please list all allergies (food, environmental, medical), associated reactions and medications:Allergy Reaction Life-Threatening?* Medication

Yes No

Yes No

Yes No

Yes No *Life-Threatening allergies are allergies that can cause severe and immediate harm to a student and could quickly result in death if not treated with emergency medical care or a life-saving injection (ie. Epi-Pen).

If allergy is life-threatening... 1. Does the student carry an Epi-Pen or similar injector? Yes No 2. Is the student aware of how to use it and capable of using it him/herself? Yes No

MEDICATION: Please list any medication(s) that the student should NOT take?

For mild headaches or mild pain, student can receive: Acetaminophen (Tylenol) Ibuprofen (Advil) Other:

Does the student take medication on a regular basis? If yes, please list:

- Will the student be bringing this medication to Canada? Yes* No

- Does this medication require injections? Yes** No* Medication carried by students will be administered ONLY IF contents and instructions are properly labelled in English.** CISS staff cannot administer needle injections to students except in the event of a life-threatening situation (i.e. Epi-Pen). Students who require injections must arrive at programme prepared to administer the injections themselves, under the supervision of programme staff.

Please list any major illnesses or surgeries the student has had in the past 5 years.

DIETARY: Is the student... Vegetarian Vegan Gluten-Free Lactose-Free Other

IMMUNIZATIONS: Please list the date of the last immunization for each of the following:

Varicella (Chicken Pox): Has the student had chicken pox? Yes No Tetanus:

GENERAL WELL-BEING:

Overall, the student’s general health is: Excellent Good Poor (please explain):

Has the student suffered from, or is the student being treated for any mental/nervous disorder - including, but not limited to, Anxiety, Depression, Attention

Deficit Disorder (ADD), Anorexia? No Yes (please xplain):

Has the student experienced any emotional trauma that may affect his/her behaviour while at our CISS programme (ie. recent death in family, divorce, accident)? No Yes (please xplain):

Student wears prescription glasses/contacts: Yes No Dental braces: Yes No Hearing Aid: Yes No

Student is... Diabetic Epileptic Student can swim? Yes No

Student has issues with: Nightmares Bed-wetting Homesickness Sleepwalking

Please list any activities in which the student should NOT participate in:

Is there anything else we should know about your child?

ROOMING: My child would like to share a room with - Choice #1: Choice #2:*Requests will be considered but cannot be guaranteed.

Additional Notes:

HEALTH/MEDICAL INFORMATION

EXTRA FEES1. In addition to included activities and excursions, CISS MLI programmes also offer some optional excursions. These are provided to students at minimal cost and presented upon arrival at camp (CISS St. Michael’s, CISS at Trinity & CISS Vancouver) or at the time of registration (Lakefield & Swallowdale). Payment is made by the student/parent at time of selection. For city residential programmes, costs are determined and may vary depending on the number of participants.2. If a student requires a Visa, a Notarized Custodianship Fee of $100 CAD per student may apply. 3. Extra Day Fees include: accommodation, meals, supervision, medical insurance and programming as per the schedule - additional lessons are not included. 4. Leader in Training (LIT) Practicum option is an additional cost and is offered to students at the time of registration. Please refer to the CISS MLI Price List for further information or contact your agent, or CISS MLI representative.

TRANSFER NOTES 1. Airport arrival and departure transfers between the gateway airport and programme site are included for students arriving and departing on scheduled dates. Students travelling on non-scheduled arrival or departure dates may incur extra fees.2. If a student is travelling as an Unaccompanied Minor (UM), a one-time fee of $75 CAD per student will apply. 3. Early Morning Departure Fees apply to all students with flights scheduled to depart before 08:00.

CONDITIONS & POLICIES1. CISS MLI will not accept responsibility for money lost or stolen. Similarly, CISS MLI will not be responsible for damage, loss or theft of any student’s personal belongings, including clothing collected for laundry. Students are encouraged not to bring valuables. 2 . The camper and his/her parents/guardian understand that all rules of the programme must be followed. Failure to abide by the rules and policies of the programme may result in dismissal. There will be no refunds paid if the participant is dismissed.3. CISS MLI and its staff take photographs and video content during the camp sessions to be used for promotional purposes including, but not limited to: website, programme brochures, advertisements and for use by CISS MLI agents to promote this programme internationally. Except in cases of testimonials used on our website, social media or in brochures, camper names are not typically used in connection with the photograph(s). If you wish for your child to not be photographed, please let your agent or a CISS MLI representative know in advance. 4. Leader in Training (LIT), Global Leadership or Academic & Career Prep programme require a separate application form that must be completed to assess English and aptitude level for the programme. HEALTH & MEDICAL - PARENT / GUARDIAN AGREEMENTTo the best of my knowledge, my child is in good health and has not been exposed to any infectious disease in the past four weeks. In case of surgical emergency, should we not be immediately available for consultation, I hereby give permission to the physician selected by the Camp Director to hospitalize, secure proper treatment for, and to order injections, anesthetics or surgery for my child as named above.

I hereby agree that the relationship and the resolution of any and all disputes arising therefrom between myself and health services provided through CISS MLI shall be governed by and construed in accordance with the laws of the Province in which the programme operates. I hereby acknowledge that the treatment will be performed in the Province in which the programme operates and that the courts of the Province in which the programme operates shall have jurisdiction to entertain any complaint, demand, claim or cause of action whether based on alleged breach of contract or alleged negligence arising out of the treatment. I hereby agree that if I commence any such legal proceedings they will be only in the Province in which the programme operates and hereby irrevocably submit to the exclusive jurisdiction of the Courts of the Province in which the programme operates.

I hereby waive, release and absolve and agree to indemnify and save harmless CISS MLI and their respective officers, employees and agents from all liability arising from my child’s participation in their programme, except such as results solely from its or their willful neglect or willful default.

Medication carried by students will not be administered if contents and instructions are not properly labelled in English. Students who require daily injections must arrive at camp prepared to administer the injections themselves, under the supervision of CISS MLI staff. CISS MLI health care providers are not permitted to administer injections except in the event of an emergency (i.e. Epi-Pen).

It is the responsibility of the parent/guardian to inform CISS MLI if there are any changes in the child’s medical condition after this form has been submitted to CISS MLI.

I confirm that my child is capable of participating safely in the full programme and all activities unless I otherwise advise CISS MLI in writing. I acknowledge that such participation involves risks and hazards incidental thereto all of which are assumed by me. I agree to be responsible for any extra expenses incurred by my child or by CISS MLI on behalf of my child.

I have read, understand and accept the conditions and policies on this form.

Parent/Guardian Signature: Date:

STUDENT: DATE:

PROGRAMME POLICIES

3 of 3

payment form

ST. MICHAEL’S City Residential LAKEFIELD CAMP International

transfers arranged only to/from

Pearson International Airport (YYZ)

I would like to pay the total owing by credit card: Visa Mastercard American Express

Credit Card Number Expiry Date /

Name of Cardholder Signature

I would like to pay the total owing by bank wire/transfer:

Canadian $ payments:

Canadian International Student Services

439 University Ave, Suite 2110

Toronto, Ontario, CANADA M5G 1Y8

Tel: +1 (416) 646-5400

Fax: +1 (416) 646-5403

TD Canada Trust Bank

2 St. Clair Avenue East

Toronto, Ontario, CANADA M4T 2V4

Swift code: TDOMCATTTOR

Transit #: 19682

Account #: 0617-5275714

*Notes:

1. Extra day prices include: accommodation, meals, supervision, medical insurance and programming as scheduled.

3. Special transfer fees apply ONLY when student arrives or departs on a non-scheduled arrival or departure day as per our session listing, and

requires CISS to arrange a special transfer. There are no additional transfer fees when arriving/departing on scheduled arrival or departure days.

4. Payment details must include the student’s name. Please ensure that all bank / service charges are paid as CISS will not be responsible for assuming these fees.

I authorize CISS (Canadian International Student Services Inc.) to perform the following transactions.

These charges represent payment for the above mentioned programme for my son/daughter.

*please note that a service charge of 3% CAD will be charged on payments made by credit card.

Please ensure student’s name is indicated on transfer form, and payment of all service fees is arranged by you. Payment to be made by bank transfer, international money order or bank draft to:

------------------------------------------------------------------ OR------------------------------------------------------------------

CR

EDIT

CA

RD

BA

NK

WIR

E

Clear Form

SUMMER

4 weeks: 3 weeks:

2 weeks:

Student NAME:

Please select the session for which the student is registered:

ADDITIONAL FEES Extra Day St. Michael’s >>> Indicate specific dates:

Lakefield Camp >>> Indicate specific dates:

be scheduled between 11:00 - 19:00) Lakefield

Extra Transfers St. Michael’s

(Apply only if an extra day is required. Arrival

and departure times for extra transfers must