2022 Staff Information Form

Home
About
Register
Staff
Contact Us
Donate
My Account

Select Page

Staff Information Form

"*" indicates required fields

Your Name*

First Last

Date of Birth*

Your primary email address*

Your primary phone number*

Your mailing address*

Street Address Address Line 2 City Province Postal Code

Hidden

Direct deposit information

Accepted file types: jpg, jpeg, gif, png, pdd, Max. file size: 15 MB.

If you are receiving an honorarium, please upload a copy of a void cheque or direct deposit information form.

Hidden

Social Insurance Number

Emergency contact name*

First Last

Relationship to emergency contact*

Emergency contact primary phone number*

Emergency contact secondary phone number (if available)

Health card number*

Have you had / do you have any of the following health issues:

Type 1 Diabetes?

Allergy to food?

Allergy to medication?

Other allergies?

Epilepsy?

Celiac disease?

Other physical health concerns you would like us to know about?

Other mental health concerns you would like us to know about??

Please explain the allergic reaction and the treatment required

Please describe these health issues and their treatment

How is your insulin delivered?*

Pump

Injections

Do you regularly take medication (and will be at camp)?*

Yes

Please list all medications, dosing information, and reason for taking.

Please note that depending on your role at camp and the type of medication, you may be required to store this in the health centre with our medical team.

Do you have any dietary restrictions, aside from allergies?

Vegetarian

Vegan

Dairy restrictions

Gluten restrictions

Meat/protein restrictions

Other dietary restrictions

Please detail these restrictions for our dietetic team, listing any substitutions you commonly use.

With my signature below, I certify that all information provided on this form is, to my knowledge, accurate and complete.*

Camp Banting

Established 1953

Canada's longest running camp for children living with type 1 diabetes.

Charitable registration number: 7866 62478 RR0001

Home

FAQ

Alumni

Come find us on social!

Camp Banting's digital world is passionately designed and powered by

The Phoenix Loop