Change Conference

Name

Youth's Phone

This address will receive a confirmation email

Parent/Guardians Name

Parent/Guardians Phone Number

Parent Guardians Email

Birthdate

Address

Do you have any allergies or take any medications?

Health Card Number

Conditions of Enrolment and Informed Consent

While every precaution is taken for the 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 at Plattsville Church. I/we understand and accept these risks and agree that by allowing my child to participate in those activities, he/she may be taking part in an activity that presents the potential for personal injury.

I/we, the Parents or guardians named below, authorize the Pastor or one of Plattsville Church personnel to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above.

I/we, named below, undertake and agree to indemnify and hold blameless Plattsville Church, its personnel, its leaders and Board from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Plattsville Church, as well as of any medical treatment authorized by the supervising individuals representing Plattsville Church. This consent and authorization is effective only when participating in or traveling to events of Plattsville Church.

I have read, understood and agree with above.

I hereby consent to the participation of my child in this supervised activity.

The Plattsville Staff Personnel reserves the right to dismiss a youth who is a hazard to the safety and right of others, or who enters the hotel room of the opposite gender. The parents or guardians submitting this application are those having legal custody over the youth. I give permission for Plattsville Church to use any photograph or video footage my child is in for promotional materials. The parents/guardians hereby agree to reimburse the Church for any damage caused by the applicant youth. Any medical, behavior, or one on one conditions have be mentioned on this application. I have read all of this application form, and I hereby accept the conditions of enrollment.

Type name as consent:

Payment

Description

The Plattsville Church youth group will be attending the YFC Youth Change Conference. This is a conference held in Toronto on October 14th and 15th at The Church on the Queensway. We will be staying overnight at the Hilton Garden Inn in Oakville.
We will be travelling to and from the event in the vehicles of leaders. Leaders will have hotel rooms beside youth, and youth will be sharing a room with up to 3 others of the same gender.
Departure: from Plattsville Church. Friday @ 4pm
Return: late Saturday evening.
For more details see https://changeconference.com/toronto/
Or ask Libby (libby@pemchurch.ca)

Change Conference

Description

Please Fix the Following