Spring Youth Retreat

Living Skies Region Spring Youth Retreat 2021!
Grades 7-12

WHERE: St. Andrew's UC (Moose Jaw) & Lumsden Beach Camp

WHEN: Friday, May 13th, 7:30pm to Sunday, May 15th, 1pm

COST: $50/participant

We're excited for a great weekend for youth aged 13-18ish. Laughter, friendship, faith and good times. We're going to learn about the cool things that make each of our personalities unique and how that affects the way we experience and impact the world around us. It's gonna be awesome.

Oh yeah, and the plan is to go to Lumsden Beach Camp on Saturday afternoon, so pack some weather-appropriate clothes!

Registration Deadline: Friday, May 6th

Support funding is always available so everyone is able to take part. Just contact Kent at 306-221-5529 or kmohn@united-church.ca and we'll make it work.

***Remember to bring your sleeping bag, pillow, sleeping pad/mattress & some warm clothes!
Participant Registration Form

Please ensure that all sections are completed.
A. Personal Information
Participant Name:*

First Name Last Name
Mailing Address:*

Address

Address Line 2

City Province

Postal Code
Participant Email Address:
Phone Number:*

Area Code Phone Number
Birth Date:

Month Day Year
Grade:
Gender:
Home Congregation (if not connected to a particular congregation, please leave blank)
Photo Waiver: I agree that event photos may be included in the electronic communications of YAYAC. We don't publicise any names or other private information.

YesNo
B. Health and Dietary Information

(Please note: all information is confidential)
Saskatchewan Health Card Number:*
For the health and safety of everyone involved in the Fall Youth Retreat, all participants MUST be vaccinated for COVID-19.*

Yep, I am vaccinated against COVID-19.
Please provide all health information, dietary restrictions, or other considerations (medications, allergies, accessibility, etc).
C. Parent/Guardian Permission

(For all participants under the age of 18)
1. Parent/Guardian Name:*

First Name Last Name
Parent/Guardian E-mail Address:*
Parent/Guardian Contact Phone Number:*

Area Code Phone Number
2. Emergency Contact (if different from above):

First Name Last Name
Emergency Contact Phone Number:

Area Code Phone Number
Anything else we need to know that hasn't already been covered above?
I hereby give permission for my youth to participate in the 2021 Fall Youth Retreat as coordinated by YAYAC - the Youth & Young Adult Community of Living Skies Region, United Church of Canada.

In the event of emergency, I also consent to any medical attention or other care/treament considered necessary by the program leadership.
Signature of Parent/Guardian (don't worry - messy signatures are ok!)*

Clear
D. Registration Payment

Cost: $50/participant
Preferred Payment Option*

Credit Card (through PayPal)Cash or Cheque (payable upon arrival at the event)I would like to apply for financial assistance
Credit Card payments: Please check the checkbox, and PayPal Portal will open when you press "Submit Registration Form" button below.
prevnext( X )
Participant Registration Fee$50.00CAD

Total $0.00CAD
E. Submit Registration Form

Last step: Press the "Submit" button below. Please note that this will also open the PayPal portal if you've indicated that you're paying by credit card.
F. Leadership Team Info (just in case you're wondering)

Feel free to contact us if you have any questions or concerns.
Josie Williamson is the Program Animator for the Youth & Young Adult Community (YAYAC) in Living Skies Region.

Kent Mohn is the regional Minister in support of Youth & Young Adult Ministry for Living Skies Region (geographic Saskatchewan).

Kent: KMohn@united-church.ca or (306) 221-5529

Josie: lsyayac.josie@gmail.com
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Participant Registration Form

A. Personal Information

B. Health and Dietary Information

C. Parent/Guardian Permission

D. Registration Payment

E. Submit Registration Form

F. Leadership Team Info (just in case you're wondering)