2022 Home Team Leader Registration

HOME TEAM LEADER (HTL) REGISTRATION FORM

Registration is open until 2:00 pm Friday, March 21, 2025.

Full Name*

First NameLast Name

Preferred Name:

Check if you are:*

Rostered MinisterHome Team Leaderother

If other, please specify:

Birth date:*

YearMonthDay

Gender: *

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail*

example@example.com

Cell Phone Number*

Congregation/Parish Name*

Congregation/Parish Location:*

Congregation/Parish Phone:*

I am a member of: *

Evangelical Lutheran Church in CanadaAnglican Church of CanadaOther

T-Shirt Size*

I AGREE TO BE RESPONSIBLE FOR TH FOLLOWING HOME TEAM YOUTH:

A Home Team may have a maximum of 11 people (2 Home Team Leaders and 9 Youth). A congregation may send more than one Home Team. If additional registrations for your Home Team are received after the initial Home Team registration, the registrar may add their names to this form.

Youth #1

First NameLast Name

Youth #2

First NameLast Name

Youth #3

First NameLast Name

Youth #4

First NameLast Name

Youth #5

First NameLast Name

Youth #6

First NameLast Name

Youth #7

First NameLast Name

Youth #8

First NameLast Name

Youth #9

First NameLast Name

Alternate/Secondary Home Team Leader (must also fill out their own registration):

First NameLast Name

Leader-in-Training (must also fill out their own registration):

First NameLast Name

Home Team Main Contact (if more than one team is coming from your congregation):

First NameLast Name

Phone Number

Please enter a valid phone number.

Email

example@example.com

Emergency Contact Information:

Please provide the following information for your (personal) Emergency Contact:

Primary Emergency Contact:*

First NameLast Name

Cell phone:*

Relationship to you:

Second Contact Name:*

First NameLast Name

Second contact cell phone:*

Relationship to you:

Medical Information:

Health Care Number:*

Family Doctor:*

Phone Number:*

Do you have food allergies?*

yesno

List allergies:

Is your reaction anaphylactic?

yesno

Other dietary requirements?

yesno

Describe other dietary requirements (if necessary):

Please note: all dietary requirements must be identified on the registration form. No late/additional arrangements will be made at the event.

Do you have other relevant health concerns?*

yesno

Explain, if necessary:

Mobility Issues - do you require assistance? If so, specify here:

CONSENTS PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY: I understand that I need to provide a copy of a current criminal record check (issued within the past 2 years) which is included along with this registration. I agree to not use alcohol, tobacco products or drugs (other than what is prescribed to me for a known medical condition) during the tour. I also fully understand and agree to perform the responsibilities and duties as a Home Team Leader for the bus trip and gathering as outlined on www.claygathering.ca.*

AGREEDISAGREE

I fully understand that all Home Team Leaders must be 26 years of age or older and I attest that I am at least 26 years of age.*

AGREEDISAGREEI am a Leader-In-Training

I consent that the ABT Synod 2025 CLAY Pre-Trip Planning Committee and/or its representatives may seek medical attention for me during the during the 2025 CLAY Pre-Trip, and hereby authorize consent, on my behalf, for any medical procedure which may be recommended by a medical practitioner. It is understood that every attempt will be made to notify my next of kin or emergency contact person in the event that such action needs to take place.*

AGREEDISAGREE

I understand that my name and photo may be used as the result of my participation in the 2025 ABT Synod CLAY Pre-Trip and I consent tot he ABT Synod Planning Committee and/or its representatives to the use of same.*

AGREEDISAGREE

I have reviewed the information set out in the Home Team Leader registration form and certify that it is correct and accurate in all respects. I hereby confirm my intention to attend the 2025 ABT Synod CLAY Pre-Trip.*

AGREEDISAGREE

Privacy Statement: The Synod of Alberta and the Territories, and the ELCIC are committed to protecting the privacy of the personal information submitted to it by youth and parents who are registering for events. The information that youcprovide wil be used for purposes internal to the Synod of Alberta and the Territories and the ELCIC for which such information is provided. The information that you provide will be protected and retained in accordance with the Personal Information Protection and Electronic Documents Act (PIPEDA) and the Privacy Policy of the ELCIC. Further information on this policy can be viewed on the ELCIC wesite: www.elcic.ca

If you are finished with your registration form, you may print it for your records. After you have printed it, click submit to send it to the registrar. You will receive a copy of your submission at the email address from which you are registering.

HTL: please collect all fees from your youth, and then send one group payment cheque for the total fee amount. Indicate the number of people the cheque is for (i.e. 1 HTL, 5 youth) when you send it.

Please drop off or mail your cheque (made payable to Alberta Synod - ELCIC) to:

Synod of Alberta and the Territories
10014-81 Avenue NW
Edmonton, AB T6E 1W8

OR

Payments may be made by e-transfer to abtfinance@elcic.ca. Deposit payments must be received no later than March 31, 2025; final payment must be received by July 1, 2025.

ABT Synod Bus Trip Rooted and Rising