Camp Banting Waitlist Application Parent / Guardian's Name* First Last Parent / Guardian's Primary Email* Enter Email Confirm Email Home Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Parent / Guardian's Primary Phone*Child / Camper's Name* First Last Child / Camper's Birthdate* MM slash DD slash YYYY Camper / Child's Gender*MaleFemaleChild / Camper's Year of T1D diagnosis*20192018201720162015201420132012201120102009200820072006200520042003200220012000CAPTCHA