Required fields are marked with asterisks (*)

Leisure Buddy

City of Cambridge Leisure Buddy Application & Child Participant Information

(For children who require additional staff support in recreational programs)

We would like to make your child’s leisure experience a success. Please help us by completing the following information. The information you provide will be used to arrange for appropriate support and to assist recreation staff. If you need any assistance filling out this form, please contact us at inclusion@cambridge.ca

Participant Information

First Name

Last Name

Nickname

Date of Birth

My child identifies as...

Home Phone Number

Will someone be home during the day?

Yes

E-Mail Address

Home Address

Primary Contact Name

Phone Number

Relationship to Participant

Secondary Contact Name

Phone Number

Relationship to Participant

Emergency Contact Information

Contact Name

Phone Number

Relationship to Participant

Contact Name

Phone Number

Relationship to Participant