Burn Weekend Student Registration

Burn Weekend

Overnighter at Roblin Wesleyan Church
Happening March 7-8, 2025

Cost $60 for Students, $30 for Leaders

Doors open at 6pm, pick up at 8am

________________________________

Payment can be made by:

cash or cheque (to Roblin Wesleyan Church) or e-transfer to roblinwc@gmail.com -

Note: Please include in memo line of e-transfers Student's Name and Burn

ex: Burn - Johnny Appleseed
Students Info
Name of Child/Youth:*

First NameLast Name
Age*
Name of Church or Youth Group
If Applicable
Medical Information
Allergies/ Medication/ Dietary Restrictions:

YesNo
Will They have medication or an epipen on them

YesNo
Additional Comments about Allergies/ Medication/ Dietary Restrictions:
Any info we should know, if bringing medication they must be given to staff, with exception of an epipen
Parent's Info
Name of Parent/Legal Guardian:*

First NameLast Name
Parent/Guardian Phone Number:*
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact Info
Emergency Contact #1*

First NameLast Name
Emergency Contact 1 Phone Number:*
Emergency Contact #2*

First NameLast Name
Emergency Contact 2 Phone Number:*
Release Waiver
By signing this document, I acknowledge that if anyone is hurt or property is damaged during my child's participation in these activities, I may be found by a court of law to have waived my right to maintain a lawsuit against Roblin Wesleyan Church, and its volunteers, on the basis of any claim from which I have released them herein. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. I have fully informed myself of the contents of this PARENTAL CONSENT AND RELEASE FOR ALL ACTIVITIES by reading it before I signed it. I warrant that I possess all the rights, powers, and privileges of a parent or legal guardian necessary to execute this document with binding legal effect.
Date:*

MonthDayYear
Signature of Parent/Legal Guardian:*

Clear
Photo Release

One of the best promotional tools for Burn Weekend is the use of photos showing the night in action. To best protect your child(ren) we want to assure you that in no manner will your child’s identity be disclosed in captions on any photographic reproduction or distribution.
I give permission to Roblin Wesleyan Church to publish or display pictures of my child for use in future for Burn Weekend publications such as brochures, websites, and multimedia presentations. I agree that if photos are taken of my child, with my permission, that I do not expect, nor require, any compensation for the reproduction of such photos now or in the future
I agree to the photo release*
Should be Empty:

Burn Weekend

Students Info

Medical Information

Parent's Info

Emergency Contact Info

Release Waiver

Photo Release