Bus Trip to CLAY 2025

MNO Bus Trip to CLAY 2025

Deadline for Application: May 30, 2025
Details and inforamtion about the bus trip is at: https://mnosynod.org/mno-synod-bus-trip/
Are you registering a Youth Participant or an Adult Leader?*

Youth ParticipantAdult leader
Name*

First NameMiddle NameLast Name
Preferred Name*
Name I choose to go by
Pronouns
Ex: They/Them; He/Him; She/Her; Ze/Zir; They/She; etc.
Birth Date *

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number (if you have one)
Please enter a valid phone number.
Participant's Cell Phone Number (if you have one)
Please enter a valid phone number. This number may be used by adult leaders to communicate with participants throughout the trip.
Participant's Email
Some information about the bus trip will be sent to this address.
Home Congregation*
This is the congregation you are most directly connected to or are registering with.
Home Team Leader's Name*

First NameLast Name
Home Team Leader's Email*
example@example.com
Participant's T-Shirt Size*
Responsible Grown-Up's Information

This is an adult who has legal guardianship of the participant. This person will receive information before, during and after the trip. For adult leaders, repeat your information here.
Name*

Preferred NameLast Name
Home Phone Number*
Please enter a valid phone number.
Cell Phone Number*
Please enter a valid phone number.
Which phone number can/should leaders use to communicate with you before and during the trip?*

Home PhoneCell Phone
Parent/Guardian Email*
example@example.com. Information will be sent to this address before, during and after the trip. Leaders, use your email address.
Emergency Information
Emergency Contact's Name*

First NameLast Name
Emergency Contact's relationship to participant
Daytime Phone Number*
Please enter a valid phone number.
Is this a cell, work or home phone number?
Night time Phone Number*
Please enter a valid phone number.
Is this a cell, work or home phone number?
Provincial Health Number/s*
Manitoba residents--enter BOTH the six-digit Registration # and the nine-digit Personal Health ID #. Ontario residents--enter your Ontario Health Card number
Participant's Sex (this may be necessary in a medical emergency)*

MaleFemale
Health Alerts

Help us care for the medical needs of your Participant.
Does the Participant have any allergies, chronic illness, or medical conditions? If yes, please provide the information that will help us fully understand what the allergy, medication routine, or medical conditions are.
If the Participant has severe allergies, are you providing an Epipen?
Yes/No
SPECIAL DIETARY REQUIREMENTS (must indicate in advance) i.e. vegetarian, vegan, gluten free, etc.
Authorization & Consent

PLEASE READ THE FOLLOWING CAREFULLY
I have reviewed the information that I have put on this registration form and certify that it is correct and accurate in all respects. I consent that the 2023 Bus Trip Planning Committee and/or its representatives may seek medical attention for {participantsName} during the 2023 Bus Trip, and hereby authorize it to consent to, 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 the next of kin or emergency contact person in the event that such action needs to be taken.
Signature*

Clear
Signature of Grown-Up / Participant (if 18 years of age or older)
I agree to cooperate with my Home Team Leader and to be actively involved with the Bus Trip.*

Clear
Signature of participant
I understand that my name and photograph (including audio and visual images) may be used as a result of my attendance at this event.*

Clear
Signature of Grown-Up / Participant (if 18 years of age or older)
On Privacy

The MNO Synod 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 you provide will be used for the purposes internal to the MNO Synod and the ELCIC for which such information was provided. Personal information will not be shared with third parties without your expressed consent. 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 website: www.elcic.ca
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature*

Clear
Date

MonthDayYear
Date
Should be Empty:

MNO Bus Trip to CLAY 2025

Responsible Grown-Up's Information

Emergency Information

Health Alerts

Authorization & Consent