Overnight Form For Ellerslie Youth Ministry 2023/2024 All fields required. Event Information Ellerslie Youth will be bussing from Ellerslie Road Baptist Church to Gull Lake Centre on November 10th at 6pm and returning via bus on November 12th at 12:30pm. The Ellerslie Youth Retreat will be an offsite overnight weekend where teens will be staying in cabins supervised by approved Ellerslie Youth Leaders. There will be a variety of games, special activities, worship, teaching, small group time and more happening throughout the weekend. Participant Information First Name (required) Last Name (required) Birthdate (YYYY-MM-DD) Age Grade Gender Home Address City Postal Code Student Cell Phone (if not applicable put NA) Student Email (if not applicable put NA) Any allergies, special needs, or behavioural concerns? NoYes (if yes please explain) Will medication be brought to along? NoYes (if yes please ask for a Medication Information Form) Alberta Health Care # Emergency Contacts Contact 1 Relationship Emergency Contact 1 Phone Emergency contact 1 Email Contact 2 Relationship Emergency Contact 2 Phone Emergency contact 2 Email Consent Pictures are taken at times to remember events and share the excitement with others. Unless submitted in writing to the church, we will assume this is permissible. I hereby give permission for, , to take part and receive the advantages of Ellerslie Road Baptist Church’s ministry overnight event of Ellerslie Youth Retreat 2023 and to be transported by bussing that has been hired by Ellerslie Road Baptist Church. In the event of an emergency and medical treatment is required, I give permission to the staff and/or volunteers to obtain services for treatment as deemed necessary if I cannot be contacted in a reasonable amount of time. I recognize that there are risks inherent in activities my child may be engaged in and I waive, hold harmless, or indemnify Ellerslie Road Baptist Church, its instructors, paid or volunteer staff, successors, heirs and assigns from any action. I do hereby release, forever discharge and agree to hold harmless, Ellerslie Road Baptist Church and the representatives thereof from any and all liability claims, or demands for personal injury, sickness, or death, as well as property damage and expenses of any nature whatsoever which may be incurred by my child in the course of participation in the aforementioned. Furthermore, I agree to assume all responsibility for any of the previously mentioned occurrences. Guardian's Printed Name Guardian's Signature Date