2016 Registration Form
Registration deadline is October 7, 2016
Please note –all information on this form needs to be filled out completely along with a waiver (to be received prior to the event, no later than October 7, 2016). This registration form can be emailed (with scanned signatures and waiver) to ; faxed to 1.506.635.0366 or mailed along with the waiver to: Convention of Atlantic Baptist Churches, Link Registration, 1655 Manawagonish Road, Saint John, NB E2M 3Y2.
Although we desire to see as many youth attend this event as possible, please note that we cannot accommodate every student who would be eligible for LINK.
Spaces will be reserved on a first come first serve basis, with preference given to those who have their completed registration form AND their waiver sent in (ie no missing information on any forms). If a student registers, and believes they cannot attend, out of courtesy to those on a potential waiting list, we ask that you please inform Jacqueline as soon as possible so that others may be accommodated.
Ages: 13 (as of December 31, 2016) – Grade 12 (Sept 2016)
Participant Information
Youth’s last name:______Youth’s first name:______Male/Female
Address:______
Street City Province Postal Code
Home Phone Number______Parent’s Cell Number ______
Mom / Dad (please circle one)
Home Church:______Youth’s Birthday:______
Year/Month/Day
Is the youth allowed to travel in a leader’s car Yes/No Youth’s grade (Sept 2016) ______
Youth’s e-mail address ______
Parent’s Contact Information
Parent Name(s):______
Parent’s e-mail:______(mother/father)
Parents grant permission for their e-mail to be sent to others attending the event to help arrange transportation YES or NO
Although no guarantees can be made with cabin requests, we will do our best to accommodate the youth’s request. Who would the youth like to room with? ______
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Health Care Information:
Emergency Contact Name:______Emergency Contact number______
Health Care Card Number:______Expiry Date:______
Youth’s Allergies (please list any allergies):______
______
Additional medical concerns our staff should be aware of?______
______
Are you interested in participating in the Sunday morning service? Yes / No
There will be a variety of activities throughout the weekend, depending on the weather, that will require different clothing such as swimming, canoeing, hiking, field sports, archery, beach volleyball, a zip line and climbing wall. Please bring appropriate clothing and footwear for these activities. Don’t forget about our Variety Show – please bring what you need to participate in this! The Variety show is open to different types of acts, including singing, drama, clean humour, and any other talents including artwork, appropriate dance, ‘stacking cups!’…. come and share your gifts with the rest of LINKers!
Parent’s Signature ______
Cost
The cost of the event is $40 for the first child and $30 for every additional child. You can send a cheque (payable to CABC) along with your registration form or give your credit card information to process on your Visa or MasterCard.
First Child Registration __ 1___ x $40 = $40
Subsequent Children ______x $30 = _____
Total Cost $______
_____ I am enclosing a cheque payable to CABC for this registration.
_____ Please charge this registration to my Visa/MasterCard as noted below.
Name on the credit card: ______
Card #: ______Expiry Date: ______3 digit code: ______
Convention of Atlantic Baptist Churches (CABC)
Waiver/ Consent form for LINK 2016 (Oct. 21 – 23, 2016)
Youth’s Name: ______(please print)
Date of Birth ____day, ____month, ____year
I, the undersigned, give my permission as the parent/guardian of ______(youth’s full name) to participate in the activities of the LINK retreat at Bayside Camp (NS) and that this participation is at the youth’s own risk. I am aware of the inherent hazards involved in the outdoor and indoor activities that take place in a retreat setting (such as but not limited to canoeing, hiking, swimming, field sports, archery, volley-ball, zip-line, climbing wall).
Throughout the LINK weekend precautions will be taken for the safety and health of your child but in the event of an accident, sickness or misfortune, I the undersigned hereby release: the Convention of Atlantic Baptist Churches, its board members, staff, employees and volunteers, facilities as well as Bayside Camp, its Director, volunteer staff members, its board members, employees or facilities from 1) the loss or damage of personal property, 2) any and all liability in the event of any accident or misfortune that may occur to the youth named above and 3) all claims, demands, damages, actions or causes of action which may arise or result from the youth’s participation in LINK activities, whether in law or in equity and which we our heirs, executors, administrators and assigns may have.
______(parent’s signature)
In the event of an emergency, I hereby give permission to the physicians selected by the staff at LINK to hospitalize and secure proper diagnostic services, and medical treatment, for my child named above and that the parents/guardians will be notified as quickly as is reasonable
______(parent’s initials)
By signing this form, I have read, and understood the above information and acknowledge that the information provided on the online / paper registration form is correct regarding my child(ren) named above including allergies, emergency contact information, medications and health care card information.
______(parent’s initials)
I also agree that photos and or video may be taken of my child(ren) during LINK and that they may be used in retrospective, promotional pieces (for example video, flier, web story, Convention Connection), or presentations that may or may not appear on the internet.
______(parent’s initials)
Parent/guardian’s Name: (please print)______
Signature: ______
Date: ______