Clone of Bedlam 2025 Registration

Jr High One Day Retreat

Attention all grade 6 to 8 students, come on out and join us on Saturday March 28th for our one day Jr. High Retreat. This will be an event that's filled with games, sessions, worship, and tons of fun! Both lunch & dinner will be provided.
Student Information
Students Email (optional)
example@example.com
Students Cell Phone (optional)

Area CodePhone Number
Parent/Guardian Name*

First NameLast Name
Email*
example@example.com
Cell Phone #*

Area CodePhone Number
Additional Parent/Guardian Name

First NameLast Name
Email
example@example.com
Cell Phone #

Area CodePhone Number
Parent's Home Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Medical Information
Information received is confidential and is being gathered for the purposes of serving your child while in the care of BAC. Any medical information collected here serves to authorize BAC, and its staff and volunteers, to obtain medical assistance in emergencies.
I/We give consent for the Ministry Personnel of Bramalea Alliance Church to administer the following in the event of a medical emergency (answer no if your child does not carry these medications):*
Does Your Student Have Any Allergies, food or otherwise? (if not applicable please write "N/A", if you have multiple students on this form please write down the name of the child you are writing about)*
Does Your Student Have Any Medical or Behavioural Concerns (if not applicable please write "N/A", if you have multiple students on this form please write down the name of the child you are writing about)*
Will any of your Student be brining any medications with them (including epi-pens, asthma inhalers, and any over the counter medicine*

YesNo
Medications *Please put all medications (excluding Epi-Pens and Asthma inhalers) in a LABBLED Ziplock bag with your students first and last name and include the dosage and how to administer instructions*
Check the Medications that CAN be given to your student*
Purposes and Extent for collecting personal information:

Bramalea Alliance Church is collecting and retaining this personal information for the purpose of enrolling your child in our program, to assign the student to the appropriate classes, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our church. This information will be maintained permanently as it is a requirement of our insurance company and legal counsel. If you wish Bramalea Alliance Church to limit the information collected, or to view your child's information, please contact us.
Release and Permission of Parent/Guardian:
Payment options: E-transfer & Cash.*

Cash handed to Emma Donnan (BEFORE due date)E-transfer to paybac@bachurch.com - in the comment section please write "_(child's name)_ payment for Jr High Retreat"I am a Jr High Youth Leader
Signature of Parent/Guardian*

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If there is anything else that you would like Pastor Emma to know about your Youth, please feel free to write below.
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Jr High One Day Retreat

Student Information

Medical Information

Purposes and Extent for collecting personal information:

Release and Permission of Parent/Guardian: