Sharing Across Cultures Registration

Sharing Across Cultures: Food, Fun and Faith Registration

Saturday, September 24th from 11:00 am - 7:30 pm at Knox United Church in Winnipeg
A One Day Event especially for Youth Grades 7+ who identify as BIPOC (Black, Indigenous, and People of Colour)

Prairie to Pine Region
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 Name Last Name
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. Then click the back arrow to come back to the registration.
The pronouns the registrant goes by.
examples: he, she, they, zie... (see above if unsure)
Birth Date: *

Month Day Year
Parent/Guardian E-mail Address (registrants over 18, please use your own): *
Parent/guardian name (for participants under 18)

First Name Last Name
Participant Email (ONLY if different from the email entered above):
... Leave blank if same as above
Main Phone Number: *

name Phone Number
Accessibility
Dietary allergies and restrictions: Please describe below any dietary needs, their severity, and what you need us to do to ensure the participant’s safety and comfort. Note: We are an allergy-aware event but cannot guarantee an allergen free environment. Also while we try to accommodate special needs and requests submitted to us in advance, not all may be possible. If none, type "none". *
Additional needs: If you have non-dietary allergies or other medical or emotional needs that would be helpful for us to know ahead of time, to make this event more accessible to you, please describe them below.
We like to take pictures at the event to share what youth are doing at events and to advertise future events. These pictures might be used on the website or on our Instagram or Facebook accounts. Names of the youth will not appear with the photos. I give permission for photos of this participant to be used for these purposes. *

yes yes, but only if their face is not visible no, and I will make the participant aware of my wishes
Emergency Contact Information
1. Name of person who will be reachable during event, in case of emergency *

First Name Last Name
Emergency contact's Phone Number: *

Area Code Phone Number
2. 2nd emergency contact (optional):

First Name Last Name
2nd Emergency Contact's Phone Number:

Area Code Phone Number
How did you hear about this event, or who told you about it?
Anything else we need to know that hasn't already been covered by any of the above?
Registration Fees $0.00 - This is a free event!!!

We just want you to come and have fun! Feel free to invite friends to register, too.
Questions?

Contact Twila MacNair at tmacnair@united-church.ca or (204) 781-8124
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.”
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Sharing Across Cultures: Food, Fun and Faith Registration

Accessibility

Emergency Contact Information