Pacific Mountain General Meeting 2025

Minor Permissions

All youth attendees who ARE NOT MEMBERS OF YOUTH COUNCIL must fill out the following forms & questions with the support of a parent or guardian.

The following contact information must be of the onsite (attending the AGM and/or staying in Nanaimo to support the youth) adult who is 'in charge' of the youth outside of AGM programming.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Relationship to youth*
Has this person completed a Criminal Record Check that is on file with First Third Ministry?*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/ Guardian’s Agreement for:
Liability Release and Waiver, Medical Permission
Pacific Mountain and Chinook Winds Regions, United Church of Canada

IMPORTANT:

By signing this document, you are waiving certain legal rights including your right to sue.

PLEASE READ CAREFULLY

Parent/ Guardian’s Agreement for:

Liability Release and Waiver, Medical Permission, Photo Release

Pacific Mountain and Chinook Winds Regions, United Church of Canada

Event: Chinook Winds Annual General Meeting, Lacombe Memorial Centre, Lacombe, AB

Request to Participate

I hereby request my child(ren) to participate in the Event on May 8-11, 2025
Signature*
Assumption of Risks Associated with the Event

I am aware that the Event involves participation in various activities typical to retreat settings. Programs might include watersports (canoeing, kayaking, swimming, etc.), hiking, outdoor play, visual arts, small group activities, etc. I understand that the foregoing does not list all of the risks or dangers and that participation in the Event involves risks and/or dangers which are not foreseen. I also understand that the risks or dangers associated with the Event involve a risk of injury to any and all parts of my child(ren) body which could result in serious personal injury, death and/or property loss. I hereby agree to freely and expressly assume and accept any and all risks to my child(ren), both foreseen and unforeseen, while participating in the Event.
Signature*
Liability Release and Waiver

In consideration of being allowed to participate in the Event, I hereby assume for my child(ren), any and all risks, dangers and hazards associated with the Event (including any risks, dangers or hazards which are unknown at this time) and hereby release and forever discharge The United Church of Canada, The Pacific Mountain Region of The United Church of Canada, the Chinook Winds Region of the United Church of Canada, PDC, Camp societies, their directors, officers, employees and agents and any sponsor of the Event. I release their officers, directors, employees, contractors, subcontractors or agents during the Event from any and all liabilities, claims, demands, damages, actions, suits or causes of action, including any claims for breach of contract, negligence or gross negligence, statutory or other duties arising from the Event.
Signature*
Medical Permission

I give permission for any medical treatment necessary during the event for my child(ren). In the event that my child/youth is injured, ill or in need of medical attention (and I am unable to be contacted), I/we authorize the Leaders of the event to seek medical attention on my behalf. I give permission for the first aid person to administer over the counter medication to my child/youth if required.
Signature*
Acknowledgement

I hereby acknowledge:
1. I have read and fully understand this Liability Release and Waiver, Medical Permission and Photo Waiver and Release Form and have signed this document of my own free act;
2. If I do not want to sign this document I can choose for my child(ren) not to participate in the Event;
3. By signing this document I am giving up my right to sue anyone in relation to anything which happens to me or my child(ren) as a result of my participation in the Event;
4. This document binds me both me and any person who might stand in my place in the event of my injury or death, such as my family, heirs, executors, guardians or administrators;
5. This Document constitutes the final and entire agreement between myself and the persons and firms released by this Agreement.
Signature*
Name of Parent/Guardian who completed the above permissions*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number

Children's Program

We are running a Children and Young Teens Program at the Pacific Mountain Annual General Meeting. This program is for ages 8-14, who will be split into groups and will run parallel to the AGM with arts, games and other activities in the community. It is not an overnight program, and follows the same hours as the AGM schedule. Registration can be found on Amelia at THIS LINK.

Total amount to be paid
Payment Options (if you have to pay for meals - Visitors/Guests)
E-Transfer Payments

Receipient: Finance.PacificMountain@united-church.ca
Note to Receipient: Meals 2025 AGM

Cheque Payments

Payee: Pacific Mountain Regional Council
Memo line: Meals 2025 AGM
Mail Cheque in to the Pacific Mountain Regional Council Office
Payment Method: How will you complete payment for the Optional Meal Package(s) you are ordering?
Other Comments
Confirmation*
Should be Empty:

Welcome to the 2025 Pacific Mountain Region General Meeting Registration!