Vous êtes sur la page 1sur 2

Earlybird Registration - 50$

(by Oct. 8th)


Regular Registration - 65$
(after Oct. 8th)
NO REGISTRATIONS
ACCEPTED AFTER OCT. 15th
Make Cheques Payable
to your Youth Ministry

------------------------------------STUDENT REGISTRATION--------------------------------
AWAKEN HUB Options: (please only select 1)
#1. Reach My Community - Gideons Team
#2. Tattered Tiaras (Girls Only*) - Kim Moran + Team
#3. What Has the Cross Changed? - Ryley Heppner
#4. Living the Change in Your Environment - Ruben Valeny
#5. Leaders Seminar (Leaders/Pastors only) - Ben Johnson

WHAT TO BRING?

Sleeping Bag
Pillow
Bible
Spending $$$
Appropriate
Clothing

AWAKEN ACTIVITY Options: (please only select 1)


Blue Option: Reach THE Community
Red Option: Inflatable Kingdom (@ GFSS Gymnasium )
Yellow Option: Floor Hockey / Gymnasium Games (@ Perley Gymnasium)
Purple Option: Swimming/Skate Jam (@ Grand Forks Aquatic Center)
Pink Option: High Ropes, RC Racing (In 45 minute rotations @ Pines Bible Camp)
Orange Option: Paintball Option (limited space available)
Brown Option: Hayride/Western Photobooth (limited space available)
(Buses will be provided to transport youth to their Activity Options)

Name:__________________________________________________________________

Male ( ) Female ( ) Grade:__________ Age:_________


Parent/Guardians Name_____________________________________________
Address:__________________________________________________________
City: _________________________ Province: _______Postal Code:__________
Phone:____________________________________________________________
Medical Info:
Health Number:____________________________________________________
Allergies: ___________________________Medications:___________________
HUB option #:____________________________________________________________
ACTIVITY option Color:__________________________________________________
Parent Signature:__________________________________________________
(Please also sign your groups waiver form for weekend trips)
HAND THIS FORM IN TO YOUR YOUTH LEADER

WEEKEND BREAKDOWN

WAIVER & MEDICAL RELEASE


Activity:

FRIDAY
6:30pm-8:30pm LATENITE CONCERT with BEN WARD & KIROS
8:45pm-11:00pm MISSION IMPOSSIBLE & CAMPFIRE SESSION

SATURDAY

12:00am LIGHTS OUT

8:30am BREAKFAST @ GOSPEL CHAPEL


10:00am-12:00pm SESSION 1wi/RESONATE & CLARK MORAN
12:00pm LUNCH @ GOSPEL CHAPEL
1:00pm-2:00pm HUBS @ GOSPEL CHAPEL
2:00pm-5:00pm ACTIVITY OPTIONS
5:00pm DINNER @ GOSPEL CHAPEL
(FREE TIME UNTIL 6:30pm)
6:30pm-10:30pm SESSION 2 with OH, VILLAGE / RESONATE &
CLARK MORAN
12:00am LIGHTS OUT

SUNDAY
8:30am BREAKFAST @ GOSPEL CHAPEL
10am-12:00pm SESSION 3 with RESONATE & CLARK MORAN
12:00pmFINAL DISMISSAL

WHAT TO BRING:

AWAKEN 2013 (October 18


18
October 20)

Chaperones:___________________________________________________________

Sleeping Bag / Pillow / Tooth Brush / Deodorant


A Bagged lunch / snack for FRIDAYS trip
Bible
Appropriate Cloths (swimsuit if swimming ect.)
Some Spending $$$

Name of Child/Student __________________________________

Age ___________

Address __________________________________________Postal Code ___________


Phone ____________________________________School ______________________
Does your child have any severe allergies? (bee stings, food, penicillin, other drugs)
YES_____NO__________ If yes, please explain:
______________________________________________________________________
Does your child have any life-threatening allergies? YES ______NO _________
If yes, please explain:
______________________________________________________________________
Is your child bringing any medication with him or her? (Antibiotics, ventilator, Ritalin)
YES _____________
NO ______________ If yes, please explain:
______________________________________________________________________
Does your child have any physical, emotional, mental or behavioral concerns or limitations that our staff should be aware of? YES __________NO ___________
If yes, please explain:
_____________________________________________________________________
Check if your child currently, or in the last three months, has had any of the following:
Appendicitis
Ear Infection
Hay Fever
Asthma
Epilepsy Hepatitis
Severe Stomach Ache
Tonsillitis
Bedwetting
Diabetes
Measles (Red)
Sinusitis
Chicken Pox
Fainting
Measles (German)
Mumps Other
Date of last Tetanus shot: _______________________
Precautions are taken for the safety and health of your child, but in the event of accident
or sickness, Evangel Church, its staff, and its volunteers are hereby released from any
liability.
In the event that your child requires special medication, x-rays or treatment, the parents/
guardians will be notified immediately.
In case of surgical emergency, I hereby give permissions to the physician selected by
Evangel Church to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child as named above. Your child must be covered by
Provincial Health Insurance or equivalent medical insurance.
Provincial Health Insurance Number
_________________________________________________________
Name of Family Physician
_________________________________________________________
Physicians Phone Number
_________________________________________________________
Parent/Guardians Signature:
Date:
________________________________

____________________________