YOUTH REGISTRATION
FEBRUARY 14 – 16, 2015
(Registration deadline- January 31, 2015)
Last Name: ______First Name: ______
Address: ______email______
Home Phone #: ______Home Congregation: ______
Birthdate (M/D/Y): ______Gender: M or F Age: ______
Provincial Medical #: ______
Medical Concerns:______
Allergies: ______
Special Dietary Requirements ______
Emergency Contact and Phone # Day: ______Night:______
The youth leader that I am registered with is ______
Enclosed: $75.00registrationMake cheques payable to: Saskatchewan Synod
FOR THE PARENT/GUARDIAN
- I grant permission for the Retreat Organizers to seek medical attention as required during the 2015 February Youth Gathering.
______(signature of parent/ guardian)
FOR THE YOUTH PARTICIPANT
- I agree to cooperate with the leaders and be an active participant in the gathering. ______(signature of youth)
- I agree to allow my name and/or photograph to be used in Synod communication as a result of my attendance at this event.
______(signature of youth)
The SK Synod is committed to protecting the privacy of the personal information submitted to it by youth and parents who are registering for events. The information that you provide will be used for the purposes internal to the Planning Committee and retained in accordance with the Personal Information Protection and Electronic Documents Act (PIPEDA) and the Privacy Policy of the ELCIC. Further information on this policy can be viewed on the ELCIC website:
LEADER REGISTRATION
FEBRUARY 14 – 16, 2015
(Registration deadline- January 31, 2015)
Last Name: ______First Name: ______
Address: ______email______
Home Phone #: ______Home Congregation: ______
Birthdate (M/D/Y): ______Gender: M or FAge: ______
Provincial Medical #: ______
Medical Concerns: ______
Allergies: ______
Special Dietary Requirements______
Emergency Contact and Phone # Day: ______Night: ______
Enclosed: ______$ 75.00 registration Make cheques payable to: Saskatchewan Synod
I agree to allow the Retreat Organizers to seek medical attention as required for me during the 2015 February Youth Gathering. I agree to assist the presenters in helping to make the gathering a positive event. I understand that my name and/or photograph may be used as a result of my attendance at this event. I have read/ agree to abide by the ELCIC Policy for the Protection of Children, Youth and other Vulnerable People (see Introduction and Policy on ) Attached to this registration is a copy of my current Police Records Check.
______(signature of leader)
I will be responsiblefor the following youth:
______
______
______
______
______