Young Adult Registration

Young Adult Registration

July 22-24, 2026 @ Summit Pacific College
Participant Name*
Birthday*

MonthDayYear
Date
Age*
Gender*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Home Church
Emergency Contact Name*
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Relationship*
Food Allergies*
Medications / Medical Conditions We Should Know About*
Health Number*
Accessibility Needs
Agreement to Follow Guidelines and Refrain from Smoking/Drugs/Alcohol Onsite and Offsite*

I agree
Media Wavier

I will allow the taking of all image producing video and photos for purposes of the camp program and for potential future distribution and viewing in local churches, on our website, on our Facebook Group page or for other publicity and publication purposes.
Media Waiver Exclusion Request*

I agree to the Media Wavier as stated aboveI request exclusion from photo/image use as described
Liablity Wavier

2.1. Waive all claims against the Church of the Nazarene in excess of public liability insurance carried by the organization.
2.2. Authorize retreat leadership to arrange emergency transportation to a local clinic or hospital in the unlikely event of injury to my child/teen.
2.3. Authorize medical personnel to administer care in the event that retreat leaders are unable to reach me in a timely manner.
2.4. Complete appropriate medical documentation prior to the start of camp that will alert retreat leadership to any life threatening allergies.
Liability Waiver Agreement*

I have read and agree to the liability waiver statement
What would make this retreat meaningful to you?
Where are you in your faith right now?
Terms and Payment

Options:

Etransfer to: giving@pacnaz.ca

Mail Cheque to:

Canada Pacific District

9012 160th Street

Surrey, BC V4N 3A5

Memo Line: Young Adult Retreat

Early Bird Rate until June 1: $250

Regular Rate: June 1-26: $300

Other Information to know:

Check-in Time: 1pm-2pm
Check-out Time: 10am

Theme: Sacred in the Ordinary: Learning to discern the kingdom of God breaking into the ordinary patterns of daily life.

Location: Summit Pacific College
35235 Straiton Rd, Abbotsford, BC V2S 7Z1
Payment Options*

Etransfer (details listed above)Cheque (address listed above)
Rate Selection*

Early Bird Until June 1Regular Rate June 1-26
Selected Rate
Anything else we should know?
Should be Empty: