Registration – Youth Camp

Participant Information

Name(Required)

First Last

Desired Name Tag(Required)

Gender(Required)

My pronouns are(Required)

Email(Required)

Primary Phone(Required)

Mobile Phone

Preferred method(s) of communication

Phone

Text message

Birthdate(Required)

Grade in school

Please enter a number from 0 to 13.

Primary Address(Required)

Street Address Address Line 2 City Province Postal Code

Parish / Church Connection

Parish / Congregation

Diocese / Ministry Area

Do you participate in youth group?(Required)

Is there someone you would like to share a cabin with?

Emergency Contact Information

Name(Required)

First Last

Relationship to Participant(Required)

Phone(Required)

Email(Required)

Alternate person authorized to pick up participant

Name

First Last

Relationship to Participant

Phone

Carpool: I can offer a ride(Required)

Yes

How many extra people can you take in your car (take into consideration luggages) ?

Health and Safety

Medical Conditions

Allergies and sensitivities (e.g. peanuts, scents, gluten, etc.)

Other information

Permission Form and Media Release

I, parent/guardian, give permission(Required)

for my child/ward to attend this outing.

for the facilitators to provide meals to my child/ward, noting identified allergies and sensitivities.

for leaders to supervise my child/ward within the duration of this event.

for emergency first aid to be given to my child/ward, including the calling of an ambulance at my cost.

for my child/ward's image to be taken in either photograph or video by staff and/or volunteers. These photos are to be used for appropriate communication for the church event.

Consent(Required)

I, the parent/guardian, understand that all due diligence will be taken by facilitators and volunteers; I also understand that at times unforeseen events happen that are outside of control. I am declaring that I will not hold All Saints' Westboro, its staff or volunteers liable for any injury or incident.

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