Instructions:
Thank you for your interest in the March 2009 Science and Visual 
Arts Co-curricular field trip to Ecuador and Galapagos Islands.  To 
apply, please complete the form below and submit it online or to Ms. 
Fitzpatrick or Mr. Ball by June 11th.  Please include a deposit of 
$100 with your application.  Successful applicants will be contacted 
regarding an organizational meeting to be held mid-June.

1)
2. Circle the day(s) you are free to have after school meetings. 
(think about extra-curricular activities, etc.)
      Monday
      Tuesday
      Wednesday
      Thursday
      Friday

2)
5. The best description of your overall level of fitness, including 
muscular and cardiovascular endurance, would be: (circle the best 
description)
      poor
      fair
      good
      excellent

3)
Full name:

4)
Student Number:

5)
Date of birth:

6)
Health card number:

7)
Name of home contact person and their relationship to you:

8)
Home phone of home contact person:

9)
Work number of home contact person:

10)
Home phone number:

11)
Grade in which you will be enrolled next year

12)
Science or Visual Arts course in which you have enrolled for next 
year:

13)
If there are spaces open, we will be able to accept students who 
are not enrolled in a senior science or visual arts course.  If you 
are not enrolled in Science or Visual Arts nest year, tell us how 
you think this trip would be connected to one or more of the courses 
you will be taking next year.  You may want to look at the 
curriculum expectation and consider the curriculum connections.

14)
Please list all of the extra-curricular activities you are involved 
in and any part-time jobs you hold.

15)
Do you have any health concerns or allergies? If yes, please give a 
description. (Include environmental, food and drug allergies)

16)
Have you ever travelled to Latin America? If so, give a brief 
description of your trip (where, when, duration).

17)
Have you ever travelled internationally? If so, give a brief 
description of your trip (where, when, duration).

18)
Describe how you cope with stress (both physical and psychological).

19)
Describe any concerns you have about visiting Latin America.

20)
To be completed by parent/guardian:
1. Do you support your child travelling to Ecuador and the 
Galapagos Islands?  Describe any concerns you may have about your 
son or daughter visiting Latin America.

21)
2. Describe three characteristics of your daughter/son that would 
make them a good traveller.

22)
3.  Would you be willing to help out with fundraisers? If so, 
please outline any ideas you may have.

23)
For the student to complete:
There have been many interested students and there will have to be 
choices made. Without going outside the box below, describe why you 
should be chosen to go to Ecuador and the Galapagos Island in March 
2009.