Nanoose Bay Fall Retreat

Nanoose Bay Camp Fall Retreat

Parallel Youth: October 4 -6. 2024
Activity: Fall Retreat at Nanoose Bay Camp

Activity Details: Pick up (Oct. 4th) and drop off (Oct 6th) at Bethel Church. Specifics will be given out closer to the date.

Cost: $90*

You are not registered until payment has been made and confirmation has been sent by the book keeper to Pastor Kaylee.

Dear Parent:

We are planning an activity as part of our programming that requires your permission prior to participation. We have provided you the details of the activity and request that you complete and sign the permission form. Please note that all physical activities have risks. The safety of your child is our primary concern. Precautions will be taken for their well-being and protection.

The risks associated with the activity include but are not limited to: car accidents, injuries, and death.

*Sponsorships are available if finances are a barrier to you coming.
Permission Form and Consent
Student's Name*

First NameLast Name
Student's Birthday*

MonthDayYear
Date
Current Grade*
Student's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child's BC Services Card Number*
Family Doctor
Doctor's Phone Number
Allergies or other medical conditions we should be aware of.*
Guardian Name*

First NameLast Name
Guardian's Phone #*
example@example.com
Guardian's Phone #*
Please enter a valid phone number.
Guardian's Email*
example@example.com
Emergency Contact (a different person then the guardian above)*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Would you like to be part of our email list for updates regarding Parallel Youth?*

Yes Parallel YouthNo Thank You
I voluntarily agree and consent to the participation of my/our Child(ren) in this supervised activity.

While every precaution is taken for the safety and good health, some sports and activities carry with them the inherent risk of personal injury beyond the risks associated with many of the recreational activities at Bethel Church. I/we understand that 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 those activities and acknowledge that I will be responsible for any injury or other loss which may occur during my Child’s participation of these activities.

I/we, the Parents or guardians named below, authorize the Pastor or one of Bethel Church’s Personnel to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above.

I/we, named below, undertake and agree to indemnify and hold blameless Bethel Church, its Personnel, its leaders and Board from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Bethel Church, as well as of any medical treatment authorized by the supervising individuals representing Bethel Church. This consent and authorization is effective only when participating in or traveling to events of Bethel Church.

I have read, understood and agree with above.

Activity: Fall Retreat at Nanoose Bay Camp
I, Full Name* hereby acknowledge and agree that by typing my name below I intend to sign this document electronically. I understand that my typed name will have the same legal effect as a handwritten signature.
Parent/Guardian's Name (Electronic Signature)*

First NameLast Name
Today's Date*

MonthDayYear
Date
Should be Empty:

Nanoose Bay Camp Fall Retreat

Permission Form and Consent