For Future Leaders wanting to pursue Leadership Roles

Friday, Jan 9th at 7:00 pm to Sunday, Jan 11th at 12 pm

Host Church pending, Winnipeg, MB

Please ensure you click the "submit" button at the bottom when you are ready to send us your completed application form.  Please note your form will not be saved unless submitted.

You will receive a "thank you" note letting you know it has gone through.

Privacy Act Information

“The United Church of Canada is committed to protecting the privacy of personal information. Personal information is collected, used, maintained and disclosed in compliance with The United Church of Canada Privacy Policy and applicable federal and provincial privacy legislation including, but not limited to, The Personal Information Protection and Electronic Documents Act.”

In the next box we are asking for the registrant's pronouns; the pronouns they like others to use when talking about them.
If you're not sure what this means, and why we would ask Learn more here.

These email addresses will be used to share information about this event as well as future events & opportunities for young adults or youth. After this event, if you don't wish to receive emails about other United Church related youth opportunities, you may unsubcribe using the "unsubscribe" button at the bottom of any email. Emails are typically sent about once a month.

Sleeping Arrangements

For this event, our hope is to have

• one all gender dorm for those under 18 (with supervision from leaders who have their record checks completed) and
• one all gender dorm for participants over 18.

Health Form

Due to popular demand, we are offering the option of filling out the Health Form (medical/emergency information) here.  If you prefer to provide this information on a paper form that the participant would bring with them to the event, please skip next page (by scrolling to the bottom and clicking next) to go directly to payment options. Look for a link to the printable form in the auto Thank You that will show up after you hit submit.

Informed Consent and Agreement of Participation 

While every precaution will be taken for the safety and good health of participants, some sports and activities carry with them the inherent risk of personal injury.  I understand that by allowing my child to participate in the activities of this supervised event, I am exposing my child to inherent risks and hazards. I accept all these risks and hazards and agree that by allowing my child to participate in these activities, I acknowledge that I will be responsible for any injury or other loss which may occur during my child's participation in these activities.

I, authorize the leaders, or their designate, to permit emergency treatment for my child if it is deemed necessary. (Efforts will be made to contact parent/guardian before treatment is given.)

I, parent/guardian, agree to hold blameless the Prairie to Pine Region of the United Church of Canada, its personnel, leaders and council from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of this event, as well as of any medical treatment authorized by the supervising individuals providing leadership at the retreat.

By clicking submit at the end of this form, I am acknowledging that I, the parent/legal guardian of the above named participant:

• am agreeing to allow the participant to attend this event, and
• have read and agree to the above statements, and
• state that any information given in the registration above is correct.

Questions?

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

Note: someone had the experience of being taken to a broken link when they hit submit. I did not get their registration. If anything seems odd when you submit, please confirm with Twila. We don't want to miss your registration!