2013 Qualicum Beach Family Day

Activities on the Civic Centre Fields Registration
Entry deadline is Monday May 20, 2013

Please provide the following information if your are interested in providing crafts, balloons, games, bouncy castles, animals, non-profit booths, entertainment and/or interactive activities between 1pm and 4pm.

Indemnity Agreement *	Yes. I have read, understand and agree with the Indemnity Agreement.
Group Name *
Contact Person *
E-mail *
Phone
Cell
Mailing Address
Mailing Address 2
Postal Code
Please provide a description of your field activity
Power required	Yes   No If Yes... What will you be powering
Water required	Yes   No
Comments
Enter Code *
Thank-you very much for your interest in supporting this year's Family Day, should you have any questions please do not hesitate to contact the planning committee. Phone: 250-738-2198 Email: info@qbfamilyday.com

PLEASE NOTE:

• Unfortunately the Family Day Planning Committee cannot provide tables, chairs or tents for use on the field.
• As a reminder no products are to be sold on the field