Impact Fall Retreat 2023

Friday, September 29th - Sunday, October 1st

Impact Youth will be holding our Fall retreat at CT Camp on the weekend of September 29th - October 1st. This is going to be an amazing weekend for our Youth to experience what CT Camp is like and to give them an opportunity to build lasting friendships with great people! We are so excited for this upcoming retreat and the great things in store for our youth group!

Please Note:
1. Registration: $100 (until September 26th)
$130 (September 27th & 28th)
2. Online Registration will close at 4:00pm Thursday Sept 28, 2023
3. For more important Spring Retreat Information make sure to follow Impact Youth @impactyouthct on Instagram

OUR BUS LEAVES CT AT 6:30 P.M. ON FRIDAY, SEPTEMBER 29TH AND WILL RETURN BACK TO CT AT 4:00 P.M. ON SUNDAY, OCTOBER 1st

Student Name*

First NameLast Name

Student's Grade

Parent/Guardian Name*

PrefixFirst NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number (Primary)*

Area CodePhone Number

Phone Number (Cell)

Area CodePhone Number

Phone Number (Work)

Area CodePhone Number

E-mail

Student's Health Card # (6)*

Student's Health Card # (9)*

Allergies Medical conditions Prescriptions

Please list any allergies and/or medical conditions the subject of this release may have. Also list any prescription medication he/she may be taking at this time.

As a parent/legal guardian of the above mentioned student, I have reviewed the information about the event, and give permission for the subject of this release to be involved in the overall activities.

I/We have reviewed the rules of the activities and agree that the subject of this release will abide them. I/We also acknowledge that if the subject of this release has to return home early for discipline violations, it will be at my/our expense.

I/We understand all reasonable safety precautions will be taken at all times by Calvary Temple and its agents during the events and activities. I/We authorize any treatment by an accredited hospital and/or physician deemed necessary for the subject of the release in case of an emergency. I/We understand the possibility of unforeseen hazards and know the inherent possibility of risk. I/We agree not to hold Calvary Temple, it's leaders, employees, and volunteer staff liable for damages, losses, diseases or injuries incurred by the subject of this form.

Signature*

If you have any questions or concerns, please feel free to contact Pastor John Pangan at Calvary Temple 204-943-4551 ext 232 or by e-mail at jpangan@ctwinnipeg.com

How will you be submitting payment (choose one):

Using the payment option below.In person at the church office (please do not fill in any info in the payment box below)

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IMPACT YOUTH FALL RETREAT 2023$130.00CAD

Total $0.00CAD

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Impact Youth Fall Retreat 2023