2025 California Breakaway Registration

CALBREAK REGISTRATION FORM

Please fill out carefully, any errors could result in a delay in your registration.
*indicates a required field

Student's Full Legal Name (as seen on Passport)*

First NameMiddle Name(s)Last Name

Birth Date*

Date

Gender*

MF

Citizenship*

Passport # (A passport is required for Calbreak. If you don't have a passport yet enter 'N/A')*

Passport Date of Issue

Date

Passport Date of Expiry (must not expire within 2 months of our return date)

Date

Address*

Mailing Address

CityProvince

Postal CodeCountry

Student Cell Number*

Area CodePhone Number

Student E-Mail Address*

Confirmation Emailexample@example.com

Current Age*

School in Sept / 2024*

Grade in Sept / 2024*

NOTE: Participation for RECENT GRADS is now an application process. Please follow link below to apply before continuing with the registration process.

CLICK HERE for Post Grad Calbreak Application Form

How many times have you been on Calbreak before?*

Were you invited by someone who is currently registered for Calbreak 2025? If yes please indicate who:

Roommate Preference #1

Roommate Preference #2

Roommate Preference #3

Who would you like to be on a bus with? (press the '+' to add more friends)

Is there another student from your household who is going to register for the trip?*

YESNO

Please list the names of other students from your household who are going to register for Calbreak.

Other Requests

INSTAGRAM

If you would like the students and staff of Calbreak to follow you on Instagram, you can enter your Instagram User Name Here

CALBREAK OPTIONS

Calbreak has many amazing options to choose from. Please review the "TOUR PACKAGE" section of the website to familiarize yourself with the various options. Please indicate your preferences here.

- Please remember that some of these options have additional fees. A PAID OPTION IS LOCKED IN ONCE THE PAYMENT FOR THAT OPTION HAS BEEN MADE. Option fees are not refundable within 30 days of the trip.

- Some of these options have limited space, a waiting list will be started once all available spots are taken. *If you change your mind about any of these options, please contact us immediately at calbreak@yfc.ca

★ TUESDAY, APRIL 22*

NEWPORT BEACH - freePROJECT SERVE LA - $25

★ WEDNESDAY, APRIL 23*

LAGUNA BEACH - freeSIX FLAGS MAGIC MOUNTAIN (includes FLASH PASS!) - $199

EMERGENCY AND MEDICAL INFORMATION

Parent/Legal Guardian #1 Name*

First NameLast Name

Parent/Legal Guardian #1 Phone Number*

Area CodePhone Number

Parent/Legal Guardian #1 E-mail Address: (we need at least one parental email address for communication)*

Confirmation Emailexample@example.com

Parent/Legal Guardian #2 Name

First NameLast Name

Parent/Legal Guardian #2 Phone Number

Area CodePhone Number

Parent/Legal Guardian #2 E-mail Address: (we need at least one parental email address for communication)

Confirmation Emailexample@example.com

Please list other important emergency contacts, their relationship to student, best phone numbers or other contact information that will be helpful in an emergency (must be other than parents/guardians).*

Sask Health #*

Medical - Name of Insurance Company (if you don’t know yet, just put N/A)*

Medical Insurance Policy Number (if you don’t know yet, just put N/A)*

ADDITIONAL MEDICAL INFORMATION

This info is ONLY for our trip nurse and kept confidential. Accurate info is needed. If the student requires emergency medical treatment or life saving medication, this info will ensure proper care and dosage is administered.

Height (in feet and inches)*

Weight (in lbs)*

Does the student have any allergies?*

YESNO

Please list the student's allergies

Does the student have any dietary restrictions and/or concerns?*

YESNO

Please list the student's dietary restrictions and/or concerns.

Is the student currently on any medications?*

YESNO

Please list all current medications.

Are there any additional health conditions or history that we should be aware of?*

YESNO

Please list any additional health concerns or history that we should be aware of.

Doctor's Name or Medical Clinic*

Doctor's Phone Number*

Area CodePhone Number

Upon completion of filling in all areas of form, click "Submit Form". You will then be taken to our payment option page and registration process will be completed. Only one student may be registered at a time. You may click "Print Form" to print a copy of this form. If you have questions please email calbreak@yfc.ca

NOTE: you should recieve the same automatic email reply to each of the email adresses entered (student, parent/guardian #1, parent/guardian #2). If you do not recieve this email, it may be in your junk box or filtered by your spam settings. If so, please call our office at 306-242-7117, ext 108, the next business day.

TERMS & CONDITIONS

I understand that I need to make a minimum payment of $499 to YFC before I am officially registered for Calbreak, and that I must pay, in full, the total fee of $2749 to YFC before Jan 31, 2025. I understand that after Jan 31, 2025, the total fee will increase to $2999, and must be paid in full by Mar 20, 2025.

I understand that if I choose to use the PayPal subscription service, my first payment will come out immediately, and will serve as my deposit.

I understand that failure to pay, in full, the remainder of trip fees by March 20, 2025 may result in the cancellation of my Calbreak registration. I understand that any outstanding balance after April 17, 2025 will incur a late fee of $100, added monthly up until any remaining balance is paid.

I understand that if I need to cancel my registration for Calbreak 2025, I will be refunded what I have already paid to YFC, minus a $250 YFC administration and processing fee. (After March 20, 2025, cancellations will be refunded minus a $750 admin and ticketing fee, and after April 9, 2025, cancellations will be refunded minus a $1250 admin and ticketing fee).

I understand that after March 20, 2025, fees paid for additional options cannot be refunded. I understand that if YFC cancels the trip due to circumstances beyond their control, they will provide families with various refund options, with one of them being a full refund.

For Security, type the message seen below:*

INFO FOR UNITED STATES CUSTOMS AND BORDER PROTECTION

ADDITIONAL INFORMATION