Western Event Registration

A 3 hour Event for Grades 5 to 12

from Prairie to Pine Region -

focussing on our friends in the western part of our region!

Sunday, March 23rd from 1:00 am - 4:00 pm

Just outside of Brandon

At this event, there will be time to interact with horses, play games with other youth, and reflect on a theme of patience and compassion. We will not be riding horses.

Bring:

a water bottle
a notebook
closed-toe shoes (crocs are not allowed) *without proper shoes people can't participate (basically no sandals or crocs)
dress for the weather there is a heated/cooled area but we will be outside for most of the time
we will be hanging out with horses, so don't wear your favorite shirt - it will probably get dirty

Please ensure you click "submit" at the bottom when you are ready to send us your completed form. You will receive a "thank you" note telling you that it has gone through.

Registrant Name (as they prefer for their name tag):*

First NameLast Name

The pronouns the registrant goes by.

examples: he, she, they, zie... (see below if unsure)

About pronouns

Why are you being asked about this, and what does it mean? Learn more here: https://bit.ly/3vj7yB9

For safety of participants and leaders, the YAAY Committee is requiring all who are attending in person to be vaccinated, unless they have a medical exemption. Please check the option that is valid for this registrant.*

This registrant is fully vaccinated and will bring proof of such to the event.This registrant has a medical exemption and will email it to Tmacnair@united-church.ca by October 16th.This registrant is fully vaccinated, but bringing proof to the event will pose a problem, so I will email tmacnair@united-church.ca by October 16th.This registrant is not attending in person.

For which location are you registering?*

Carberry (608 3rd Avenue, Carberry, MB)Knox in Winnipeg (400 Edmonton Street, Wpg, MB)I would be willing to go to either locationI will not attend in person, but would like to be notified if there is any way to join part of the event virtually

Birth Date:*

MonthDayYear

Leadership (optional question) - skip if not applicable

I am 16, or older, and would like to be contacted about how I could help out at the event.I am 16, or older, and am happy to come and participate without extra commitments.I am part of the planning team.

Main phone Number:*

Area CodePhone Number

Parent/Guardian E-mail Address*

Participant Email (ONLY if different from parent):

... Leave blank if same as above

Mailing Address:*

Address

Address Line 2

CityProvince

Postal Code

Home Community of Faith (if not connected to a particular church, please leave blank)

Community where you live*

How did you hear about this event?:

Covid Information:

Masks will be expected to be worn, except while sitting to eat.

We will have hand sanitizer available for regular use.

Proof of vaccination, or proof of exemption will be required for all participants and leaders.

Please bring clothes for the weather. We are planning some outdoor activities, that will take place rain or shine!

Due to Covid, we will not be organizing carpools. We ask that you make your own arrangements according to your comfort level.

We ask that each person bring a bag lunch. Volunteers from the host community of faith will be making supper for us. If you feel more comfortable bringing your own supper, please do so.

We are an allergy-aware event but cannot guarantee an allergen-free environment. Please describe below any allergies of which we should be aware, their severity, and what you need us to do to ensure your child’s safety and comfort. If you would like to speak to us in more detail about this, please include your phone number in the box. If none, please write "none" in the box.*

A small packaged snack will be provided. If this registrant has food allergies, please list them here.

Please describe any physical or emotional need of this registrant that would be helpful for leaders to know about ahead of time, to make this event more accessible to them.

1. Parent/Guardian/Emergency Contact Name:*

First NameLast Name

Emergency Contact Phone Number:*

Area CodePhone Number

2. Parent/Guardian/Emergency Contact Name (optional):

First NameLast Name

Emergency Contact Phone Number:

Area CodePhone Number

Anything else we need to know that hasn't already been covered by any of the above?

Registration Fee $10.00

I prefer to pay by:*

E-transfer: send to prairietopine@united-church.ca with a note "P2P youth retreat" (they have auto deposit) - if paying for multiple registrations, feel free to do it in one e-transfer with an explanation.Credit Card or PaypalOther

Fill in $10, unless you wish to pay for multiple registration at once, in which case you can fill in the appropriate total. Then when filling in additional registrations, just pick "other" and say paid with "___" (name of other registrant).

CADDescription

Note: If you chose payment by credit card or Paypal, after you hit submit, Paypal will pop up to accept payment. You do not need a Paypal account to use this. Once Paypal comes up, just scroll down to where you can click on "pay with debit or credit card." Once you make payment, don't be concerned if it indicates payment went to Living Skies Region. That is where our finance office is located.

Please check boxes, to indicate that you have read and agree with each of the following and will communicate these expectations to your registrant. (If attending only the online portion, then skip to N/A):*

This registrant will wear a mask.This registrant will attempt to keep two meters distance from other attendees and will respond kindly and quickly if reminded by others when they forget.This registrant will bring appropriate clothing to go outdoors in that day's weather.This registrant will bring their health form (signed by a parent/guardian, if under 18). Health form will be emailed out with info letter closer to date and can also be found on website under retreats.This registrant will bring a bag lunch.N/A (The above do not apply to this registrant who will only join the online portion)

Questions?

Contact Twila MacNair at tmacnair@united-church.ca or (204) 781-8124

Western P2P Youth Event Registration Form

About pronouns

Emergency Contact Information