<p> APPLICATION FORM A.C.Q. 2014 MEMBER “on the road to certification” OR ASSOCIATE MEMBER IDENTIFICATION</p><p>Name of the camp : ______Name of the director: ______</p><p>Office address :______City :______Postal code :______</p><p>Phone #1 :______#2 :______Toll free : ______fax :______</p><p>Email :______Web site :______Date of fondation : ______Last year of operation______Name of Corporation (if different) : ______Number of sites : Charitable organization Non-profit organization ______Subsidized MELS Others :______See page 2 ; fill in Non-subsidized One form per site Private camp </p><p>MEMBERSHIP « On the road to certification »</p><p>DOCUMENT REQUIRED Copy of your promotional tools (Flyer, brochure, etc.) Description of your facilities, program, equipments, services (site, activities, lodging, catering, etc.) in 80 words maximum Cheque made out to the Association des camps du Québec in the amount of 750$ + 100$ per additional site + taxes </p><p>The A.C.Q will contact you to :  Confirm the eligibility of your camp for A.C.Q. membership and send you the Toolbox and appendices of the Standards Book  Inform you of dates for the mandatory training on standards (three meeting dates per year)  Set a date for your certification visit ASSOCIATE MEMBERSHIP «Connected to camps»</p><p>DOCUMENT REQUIRED Copy of your promotional tools (Flyer, brochure, etc.) Cheque made out to the Association des camps du Québec in the amount of 750$ + taxes </p><p>Send us the membership form duly completed along with the membership fees to:</p><p>Association des camps du Québec 4545, avenue Pierre-De Coubertin Montréal, Québec, H1V 0B2</p><p>CARACTERISTICS : Fill in this form for each site Specificities regarding the clientele : Name and address of site : Co-Ed (boys and girls) ______Boys only ______Girls only Phone : ______Person in charge : ______</p><p>Type(s) of program  Âge de la clientèle Financial Accessibility Program</p><p>Residential Camp Age group : ______Fee established according to family revenu</p><p>Day Camp Age group : ______Program for early childhood (3-5 years old)</p><p>Nature Class Age group : ______Teenager programs</p><p>Groups Other : ______</p><p>Family Camp Any questions ? Special needs :</p><p>Need help to complete this Physically challenged or disabled School break form ? Intellectually challenged or disabled</p><p> [email protected] Attention deficit disorder / hyperactivity Counsellor In Training (TDA/H) (C.I.T.) 514-252-3113 1-800-361-3586 Pervasive Development Disorder (TED) Autistic spectrum disorder (TSA)</p><p>Other(s) :</p><p>Operation and capacity: Summer From ______/______to ______Places/week : ______Places/day : ______/______</p><p>Fall From ______/______to ______Places/séjour : ______Places/jour : ______/______</p><p>Winter From ______/______to ______Places/séjour : ______Places/jour : ______/______</p><p>Spring From ______/______to ______Places/séjour : ______Places/jour : ______/______</p><p>OWNER, PRESIDENT OR DIRECTOR SIGNATURE</p><p>Name: ______Function: ______</p><p>Signature : ______Date : ______</p><p>The Association des camps du Québec has the right to not reconsider a membership application before three (3) years if a false declaration is made in this questionnaire or if any false documentation is presented during the certification process. </p>