Youth Retreat

Mar 06, 2023

Youth Retreat

May 5-7, 2023

Youth, Grades 9-12, are invited to a youth retreat May 5-7, 2023 at Mill Stream Camp in Omemee.

DROP OFF: Friday, May 5th, 6 pm at the church. Arriving at Mill Stream, 7 pm.
We need parents to volunteer to drive both ways.
PICK-UP: Sunday, May 7th, 3 (ish) pm at the church.

WHAT WILL WE DO THERE?
Be together, grow friendships, laugh, eat good food, worship, learn and have fun!

WHAT’S THE COST?
$100
$175 for a family of two. Payment can be made by cheque or you can pay online here.

WHAT TO BRING:
Bedding & pillow, toiletries, all-season clothing and footwear, bible, journal, pen.

Please register below:

Youth Name *

First

Last

Email *

Phone

Grade *

Age *

Parent/Guardian Information

Parent/Guardian Name(s) *

First

Last

Email *

Phone *

Parent Guardian Name(s)

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Secondary Emergency Contact *

First

Last

Phone *

Medical Information

Allergies/Dietary Needs *We will try our best to accomodate dietary needs within reason

Does the youth require an EpiPen?

No
Yes, and they can administer the EpiPen themselves.
Yes, and they need help administering the EpiPen.

Are there any health and/or behavioural issues we should be aware of while attending the retreat? (We want to be able to accomodate your child to make their exerience a memorable one).

Is medication required to be distrubted to the youth attending the retreat?

Please note that medications must be in their original containers, labelled with name and instructions.

Waiver & Consent

While every precaution is taken for safety and good health, some sports and activities carry with them the inherent risk of personal injury beyond the risks associated with many of the recreational activities with St. Paul's Leaskdale.

Please check *

I agree

I understand and accept these risks and agree that by allowing my child to participate in these activities they may be taking part in a recreational activity that presents the potential for personal injury.

Please check *

I agree

I authorize the leader in charge or one of St. Paul's Leaskdale's personnel to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named below.

Please check *

I agree

I, the parent or guardian, undertake and agree to indemnify and hold blameless St. Paul's Leaskdale, its personnel, and Elders from and against any loss, damage, or injury suffered by the participant as a result of being part of this event, as well as any medical treatment authorized by the supervising individuals representing St. Paul's Leaskdale. This consent and authorization are effective when participating in and/or traveling to events of St. Paul's Leaskdale Youth Retreat.

Please indicate name of parent filling out form *

First

Last

Today's Date

Please check *

I confirm

I have read and understand all of the above conditions of this registration. By checking this box, I confirm that I am digitally signing this from.

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Parent/Guardian Information

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