CANADA DAY

YOUTH MINISTRY
The following information is required if attending the Canada Day celebration at MBRC On July 1st.

Name of Event: MBRC Canada celebration Pelican Lake. Driver: Don Mitchel
Time Leaving: Friday July 1st 11:15 AM Expected return time: Saturday, 12:30AM AM
Student Name
Parents Name
Parents Phone
6 digit (family #)
9 digit (personal #)

Allergies: Yes No
9 digit (personal #)
If yes, please list
PLEASE COMPLETE IF CHILD IS UNDER 18 YEARS OF AGE:

I hereby give permission for my child of Bethel Christian Assembly Salt & Light Youth off Campus I release Bethel Christian Assembly, its leaders, supervisors and staff from any claims whatever which could result from my child's participation in the voluntary activity. I also give permission for my child to be examined and/or treated in the event of an illness or a medical emergency.

to participate in the activities
Signature of Parent/Guardian

Clear
Date

Month Day Year
Date
Should be Empty: